机器人辅助腹腔镜前列腺癌根治术中保留耻骨前列腺韧带对患者排尿控制功能及生活质量的影响

Effect of preserving the pubic prostate ligament on urinary control and quality of life during robot assisted laparoscopic radical prostatectomy for prostate cancer

目的 评价机器人辅助腹腔镜前列腺癌根治术(RARP)中保留耻骨前列腺韧带(PPLs)对患者排尿控制功能及生活质量的影响。方法 回顾性选取2022年1月至2023年12月在山西医科大学第一医院行前列腺癌根治术的92例患者,作为研究对象。根据治疗方案不同分为观察组(n=46)与对照组(n=46),分别行RARP保留PPLs治疗与标准RARP术式治疗。比较两组患者的手术指标(手术时间、术中出血量、术后引流管留置时间、住院时间),治疗前及治疗后3个月排尿功能、尿控评分(ICIQ-SF)、生活质量,随访治疗后1、3、6个月控尿率。结果 两组患者的手术时间、术中出血量、术后引流管留置时间比较,差异均无统计学意义(P>0.05),观察组患者的住院时间为(10.83±1.58) d,明显短于对照组[(13.46±1.63) d],差异有统计学意义(P<0.05)。治疗后,观察组患者的最大尿道压、最大尿流量分别为(44.42±2.94) cmH_(2)O、(13.53±1.12) mLs,明显高于对照组[(39.32±3.51) cmH_(2)O、(10.38±1.01) mL/s],ICIQ-SF评分为(4.63±0.75)分,明显低于对照组[(7.35±0.87)分],差异均有统计学意义(P<0.05)。治疗后3个月,两组患者的各项生活质量评分均较治疗前明显提高,且观察组心理、生理、社会关系、环境分别为(82.04±7.52)、(84.97±4.34)、(74.81±4.31)、(75.59±4.14)分,均高于对照组[(72.35±5.52)、(74.66±5.36)、(69.21±5.35)、(68.94±4.22)分],差异均有统计学意义(P<0.05)。观察组患者治疗后1、3、6个月的控尿率分别为30.43%、63.04%、76.09%,均明显高于对照组(52.17%、82.61%、97.83%),差异均有统计学意义(P<0.05)。结论 在RARP中,与标准RARP术式相比,RARP保留PPLs手术能够缩短患者的住院时间,促进术后排尿功能的恢复,改善患者排尿控制功能,提高控尿率,进而改善患者的生活质量。

Objective To evaluate the effect of preserving the pubic prostate ligament(PPLs)in robot assisted laparoscopic radical prostatectomy(RARP)on urinary control and quality of life in patients.Methods A total of 92 patients who underwent radical prostatectomy in the First Hospital of Shanxi Medical University from January 2022 to December 2023 were retrospectively selected as the study subjects.They were divided into the observation group(n=46)and the control group(n=46)based on different treatment plans.They were treated with RARP preserving PPLs and standard RARP surgery,respectively.The surgical indicators(surgery time,intraoperative blood loss,postoperative drainage tube retention time,hospital stay),urinary function before and 3 months after treatment,urinary control score(ICIQ-SF),and quality of life between two groups of patients were compared between the two groups,and follow up the urinary control rate at 1,3,and 6 months after surgery.Results There were no statistically significant differences in surgical time,intraoperative blood loss,and postoperative drainage tube retention time between the two groups(P>0.05),and the hospital stay in the observation group was(10.83±1.58)d,which was shorter than that in the control group[(13.46±1.63)d],the difference was statistically significant(P<0.05).After 3 months of treatment,the maximum urethral pressure and maximum urine flow rate of the observation group were(44.42±2.94)cmH 2O and(13.53±1.12)mL/s,respectively,which were significantly higher than those of the control group[(39.32±3.51)cmH 2O and(10.38±1.01)mL/s],the ICIQ-SF score was(4.63±0.75)points,which was significantly lower than that of the control group[(7.35±0.87)points],and the differences were statistically significant(P<0.05).After 3 months of treatment,the quality of life scores of both groups of patients were significantly higher than those before treatment,and the psychological,physiological,social relationship,and environmental scores of the observation group were(82.04±7.52),(84.97±4.34),(74.81±4.31),and(75.59±4.14)points,respectively,which were higher than those of the control group[(72.35±5.52),(74.66±5.36),(69.21±5.35),and(68.94±4.22)points],and the differences were statistically significant(P<0.05).The urinary continence rates after 1,3,6 months of treatment in the observation group were 30.43%,63.04%and 76.09%,respectively,which were significantly higher than those in the control group(52.17%,82.61%and 97.83%),and the differences were statistically significant(P<0.05).Conclusion In robot assisted laparoscopic radical prostatectomy,compared with the standard RARP procedure,RARP preserving PPLs surgery can shorten the patient's hospitalization time,promote the recovery of postoperative urinary function,improve the patient's urinary control function,increase urinary control rate,and thus improve the patient's quality of life.