机器人辅助腹腔镜与腹腔镜膀胱颈Y-V成形术治疗BPH术后顽固性膀胱颈挛缩的疗效比较

Comparison of robot-assisted Y-V plasty and laparoscopic Y-V plasty in the treatment of refractory bladder neck contracture after BPH surgery

目的比较机器人辅助腹腔镜膀胱颈Y-V成形术(RAYV)与腹腔镜膀胱颈Y-V成形术(LYV)治疗良性前列腺增生(BPH)术后顽固性膀胱颈挛缩(BNC)的疗效。方法回顾性分析上海第六人民医院2020年1月至2023年7月行手术治疗的42例BPH术后顽固性BNC患者的临床资料,其中18例行RAYV,24例行LYV。RAYV组和LYV组的年龄[68(62,81)岁与70(61,76)岁]、体质量指数[20.7(17.6,26.1)kg/m^(2)与19.8(16.3,25.3)kg/m^(2)]、最大尿流率(Q_(max))[9.4(5.6,13.2)ml/s与8.9(6.2,12.2)ml/s]、国际前列腺症状评分(IPSS)[20.5(15,23)分与21.1(17,23)分]、生活质量(Q0L)评分[4.6(4,6)分与4.8(4,6)分]、残余尿量[84.7(58,125)ml与78.3(50,120)ml]比较差异均无统计学意义(P>0.05)。RAYV组1例术前检查示尿道外括约肌无收缩功能。两组手术过程基本相同:进入耻骨后间隙,呈倒“Y”形切开膀胱前壁和前列腺部尿道,切除膀胱颈前壁周围的瘢痕,用两根3-0可吸收倒刺线将倒“V”形膀胱壁瓣的尖端对称吻合至前列腺部尿道切开的远端。术后2周拔除尿管。比较两组的围手术期情况和随访情况。结果所有手术均顺利完成,术中无并发症。RAYV组和LYV组的手术时间[71.8(50,98)min与105.9(71,143)min]和术后引流管留置时间[2.7(2,4)d与4.5(3,7)d]比较差异有统计学意义(P<0.05);术中出血量[50.4(20,100)ml与60.8(40,150)ml]和术后住院时间[4.1(3,5)d与4.6(3,7)d]差异无统计学意义(P>0.05)。所有患者均获得随访,中位随访16.5(2,41)个月。RAYV组和LYV组术后Q_(max)[27.9(11.7,37.6)ml/s与22.4(12.3,31.5)ml/s]、IPSS[5.1(4,9)分与4.8(4,10)分]、Q0L评分[1.6(1,3)分与1.5(1,3)分]、残余尿量[5.6(0,15)ml与7.2(5,20)ml]比较差异均无统计学意义(P>0.05)。RAYV组和LYV组术后膀胱颈通畅率分别为94.4%(17/18)和95.8%(23/24),差异无统计学意义(P>0.05)。术前控尿良好的41例术后均未出现尿失禁。结论RAYV治疗BPH术后顽固性BNC的效果与LYV相当,但RAYV可缩短手术时间和术后引流管留置时间。

Objective To evaluate the efficacy of robot-assisted Y-V plasty(RAYV)and laparoscopic Y-V plasty(LYV)in the treatment of refractory bladder neck contracture(BNC)after BPH surgery.Methods A retrospective analysis was performed for the clinical data of 42 patients with refractory BNC after BPH surgery from January 2020 to July 2023,including 18 RAYV and 24 LYV.There were no significant differences between both groups(P>0.05)in term of median age[68(62,81)years vs.70(61,76)years],median body mass index[20.7(17.6,26.1)kg/m^(2)vs.19.8(16.3,25.3)kg/m^(2)],median Q_(max)[9.4(5.6,13.2)ml/s vs.8.9(6.2,12.2)ml/s],median IPSS[20.5(15,23)vs.21.1(17,23)],median Q0L score[4.6(4,6)points vs.4.8(4,6)points]and median postvoid residual volume[84.7(58,125)ml vs.78.3(50,120)ml].Preoperative examination of one patient in the RAYV group showed no contractile function of the external urethral sphincter.The surgical procedure was basically the same for both groups:entering into the retropubic space,and incision of the anterior wall of bladder and prostate urethra was performed in an inverted Y-shaped.After excising the scar around the anterior wall of bladder neck,the apex of inverted V-shaped bladder wall flap is brought to the base of the Y-shaped incision using two 3-0 running suture.The catheter was removed 2 weeks after surgery.Perioperative and follow-up data were.compared between the two groups.Results All surgeries were successfully completed without complications.The difference between RAYV and the LYV group in operation time[71.8(50,98)min vs.105.9(71,143)min]and postoperative drainage removal time[2.7(2,4)d vs.4.5(3,7)d]was statistically significant(P<0.05).There was no significant difference between both groups in term of intraoperative blood loss[50.4(20,100)ml vs.60.8(40,150)ml]and postoperative hospital stay[4.1(3,5)d vs.4.6(3,7)d](P>0.05).All patients were followed up with a median follow-up of 16.5(2,41)months.There was no significant dfference between RAYV and LYV in term of postoperative Q_(max)[27.9(11.7,37.6)ml/s vs.22.4(12.3,31.5)ml/s],IPSS[5.1(4,9)points vs.4.8(4,10)points],Q0L[1.6(1,3)points vs.1.5(1,3)points]and postvoid residual volume[5.6(0,15)ml vs.7.2(5,20)ml](P>0.05).The postoperative bladder neck patency rates in the RAYV group and the LYV group were 94.4%(17/18)and 95.8%(23/24),respectively,with no significant difference(P>0.05).In terms of urinary continence,1 patient in the RAYV group had no contractile function of the external urethral sphincter before surgery,and none of the 41 patients with good preoperative continence had urinary incontinence after surgery.Conclusions The effect of RAYV in the treatment of refractory BNC after BPH surgery is comparable to that of LYV,but RAYV can shorten the operation time and postoperative drainage time.