前列腺癌根治术后腹股沟疝的风险因素及预防策略

Risk factors and prevention strategies of inguinal hernia after radical prostatectomy

腹股沟疝(IH)是前列腺癌患者行前列腺癌根治术(RP)后常见的并发症,严重影响患者术后的生活质量,且术后并发IH的修补往往因之前手术导致的腹股沟区粘连而具有挑战性。本文综述近些年针对RP并发IH的风险因素,如手术方式、术后解剖结构改变、低身体质量指数、肌肉减少症、高龄、国际前列腺症状评分、鞘状突未闭等,并结合相关研究阐述临床常用的预防策略包括机器人辅助腹腔镜根治性前列腺切除术(RARP)联合IH修补术、保留耻骨后间隙的RARP、精索的处理、经腹膜外RARP、术中鞘状突的处理等,以期为临床泌尿外科医师提供参考,帮助改善患者术后生活质量。

Inguinal hernia(IH)is a common complication in prostate cancer patients undergoing radical prostatectomy(RP),which seriously affects their quality of life.The repair of IH is often challenging due to the adhesion in the inguinal area caused by previous surgery.This article focuses on the risk factors for IH after RP,including surgical approach,postoperative anatomical changes,low body mass index(BMI),muscle loss,advanced age,international prostate symptom score(IPSS),and patent sheath process,and prevention strategies for IH after RP,including robot assisted laparoscopic radical prostatectomy(RARP)with IH repair,preservation of the posterior pubic space in RARP,treatment of the spermatic cord,extraperitoneal RARP,and intraoperative management of the sheath like process,aiming to provide reference for urologists and to improve patients quality of life.