保留尿道括约肌功能及减少尿道狭窄的前列腺癌根治术(附28例报告)

Urethral sphincter preservation procedure and improvement urethral stenosis (report of 28 cases)

目的 探讨减少前列腺癌根治术后尿失禁及尿道狭窄的术式。方法 采用保留尿道外扩约肌、膀胱颈环状肌纤维及单侧血管神经束 ,吻合时将膀胱颈黏膜外翻固定再与尿道对端吻合的手术方式对 2 8例病人进行前列腺癌根治术。结果 尿道外括约肌保留尿失禁发生 1例 ,占3.5% ,尿道狭窄仅发生 1例 ,随访 6～ 40个月 ,最大尿流率 2 3.2～ 32 .4 ml/ s。结论 手术方式和外科技术是影响根治性前列腺切除术后尿失禁及尿道狭窄的重要因素 ,保留尿道外括约肌可以减少术后尿失禁的发生率 ,将膀胱颈黏膜外翻再与尿道对端吻合可以减少尿道狭窄的发生。

Objective To explore the improved radical prostatectomy of prostate cancer for preventing postoperative urinary incontinence and urethral stenosis. Methods Radical retropubic prostatectomy with preservation of external striated sphincter and bladder neck and nerve-sparing technique has been carried out for 28 prostate cancer patients. Results The post-operative incontinence rate of 3.5% was found in the sphincter-preserving group and in the sphincter-repairing group. The maximum urine flow rate was 23.2~32.4 ml/s. Conclusions The technique and ways of surgical were important factors in effecting post-operative urinary continence and urethral stenosis after radical retropublic prostatectomy. The preservation of external urethral sphincter could help to reduce continence rate. Radical retropubic prostatectomy with extroversion fixation of the bladder neck mucosa and end- to-end vesicourethral anastomosis was beneficial to the prevention of vesicourethral stricture.