腹腔镜根治性前列腺切除术后影响早期尿控恢复的相关因素分析

Analysis of related factors affecting early urinary control recovery after laparoscopic radical prostatectomy

目的:探讨腹腔镜根治性前列腺切除术(LRP)术后影响早期尿控恢复的相关因素。方法:选择2016年2月-2018年6月于荆州市第三人民医院和武汉大学中南医院行腹腔镜根治性前列腺切除术的患者共300例,其中术后1个月内恢复尿控的患者共108例(恢复组),未恢复尿控的患者共192例(未恢复组),比较两组患者的平均年龄、BMI、手术时间、术中失血量,记录患者术前和术后1个月的尿动力学参数,包括最大尿流速(Qmax),Qmax时的逼尿肌压力、膀胱顺应性、排尿量、最大膀胱测量容量(CBC)、剩余尿量(PVR)、功能性尿道长度(FPL)和膀胱颈水平分级。结果:术后1个月恢复尿控的患者共108例,占36.0%,两组患者术前的尿动力学指标对比,包括Qmax、膀胱顺应性、Qmax时的逼尿肌压力、排尿量、CBC、PVR对比均差异无统计学意义(P>0.05),术后两组患者的Qmax、膀胱顺应性、Qmax时的逼尿肌压力,排尿量,PVR对比均差异无统计学意义(P>0.05),但术后恢复组的FPL长度显著高于未恢复组(P<0.05),且膀胱颈水平≥1级的患者比例显著高于未恢复组,差异有统计学意义(P<0.05)。Logistic回归分析显示,保留神经血管束率、后方筋膜重建率、FPL和膀胱颈水平(≥1级)是影响患者术后1个月内尿控恢复的重要因素(P<0.05)。结论:患者的FPL、术后膀胱颈水平、神经血管束保留和后方筋膜重建是影响LRP术后早期尿控恢复的重要影响因素。

Objective:To investigate the factors affecting the recovery of early urinary control after laparoscopic radical prostatectomy(LRP).Methods:A total of 300 cases of LRP were selected from February 2016 to June 2018 in the Third People’s Hospital of Jingzhou and Zhongnan Hospital of Wuhan University:108 cases(recovery group)recovered from urinary control within 1 month after operation,and 192 cases(unrecovered group)were not recovered.The average age,body mass index(BMI),operation time,and intraoperative blood loss were compared between the two groups.The urodynamic parameters of the patients before and 1 month after surgery were recorded,including the maximum flow rate of urine(Qmax),detrusor pressure at Qmax,bladder compliance,urine output,bladder pressure volume(CBC),residual post-urinary(PVR)volume and functional urethral length(FPL)and bladder neck level.Results:A total of 108 patients recovered at 1 st month postoperatively,accounting for 36.0%.The preoperative urodynamic parameters between the two groups were compared,including Qmax,bladder compliance,detrusor pressure at Qmax,urine output,CBC and PVR,showing no significant difference(P>0.05).There was no significant difference in Qmax,bladder compliance,detrusor pressure at Qmax,urine output,and PVR volume between the two groups after operation(P>0.05),but the FPL in the recovery group was significantly longer than that in the unrecovered group(P<0.05),and the proportion of patients with bladder neck level≥1 was significantly higher in the recovery group than that in the unrecovered group(P<0.05).Logistic regression analysis showed that neurovascular bundle retention rate,posterior fascia reconstruction rate,FPL and bladder neck level(≥1)were important factors affecting urinary control within 1 month after surgery(P<0.05).Conclusion:The FPL,postoperative bladder neck level,neurovascular bundle retention,and posterior fascia reconstruction are important factors influencing the early recovery of urinary control after LRP.