Single-centre study comparing standard apical dissection with a modified technique to facilitate vesico-urethral anastomosis during laparoscopic radical prostatectomy

A modified apical dissection of the prostate to improve the efficiency of vesico-urethral anastomosis （VUA） in laparoscopic radical prostatectomy （LRP） was reported. A total of 42 patients were randomly selected and enrolled in this study. A standard LRP was performed in 21 patients （group 1）, whereas a novel, modified apical dissection of the prostate in LRP was performed in another 21 patients （group 2）. Surgical data, total operative time, VUA time, extravasation rate, catheterisation time, occurrence of anastomotic strictures, and the early and late continence rates were analysed statistically. No differences in clinical or pathological characteristics were determined between the two groups. The total operative time, VUA time, blood loss and catheterisation time were lower in group 2, which received the novel, modified technique compared with group 1, which received the standard technique to dissect the apex of the prostate （P〈0.01 for each variable）. Regarding the extravasation rate and the occurrence of anastomotic strictures, no significant differences were found between the two groups （P〉0.0.05 for each）. After catheter removal, a statistically significant difference in the continence rates was present at 3 and 30 days post operation in the two groups （P〈0.01, respectively）. At 90 days post operation, the difference, although still present, was no longer statistically significant （P〉0.05）. The novel, modified apical dissection of the prostate facilitates the VUA and significantly improves the efficacy of the procedure and early restoration of continence.

Outcome of nephrostomy balloon dilation for vesicourethral anastomotic strictures following radical prostatectomy： a retrospective study

To evaluate the efficacy of nephrostomy balloon dilation （NBD） for patients who developed vesicourethral anastomotic stricture （VAS） following radical prostatectomy. NBD was performed in patients who developed VAS following radical prostatectomy. Quality of life （QoL）, International Prostate Symptom Score （IPSS） and maximal urinary flow rate （Qmax） were evaluated. Four hundred and sixty-three prostate cancer patients underwent radical retropubic prostatectomy （RRP）, and 86 underwent laparoscopic radical prostatectomy （LRP）. Most patients （90.3%） had T2 or T3 prostate cancer and a pathological Gleason score of ; 7. Forty-five （8.2%） and four （4.7%） patients developed VAS due to radical or LRP, respectively. Forty （89%） patients underwent NBD, including three cases of repeat dilation. The median Qmax was 4 ml s- （interquartile range （IQR）, 2.3-5.6） before dilation and improved to 16 ml s- （IQR, 15-19） and 19 ml s-1 （IQR, 18-21） at the 1- and 12-month follow-up, respectively （P〈 0.01）. Fifteen （37.5%） patients had urinary incontinence prior to dilation, whereas only three （7.5%） patients had incontinence 12 months following dilation （P 〈 0.01）. The median IPSS score improved from 19 （IQR, 17-24） before dilation to 7 （IQR, 6-8） at 12 months following dilation, and the QoL score improved from 5 （IQR, 4-6） before dilation to 2 （IQR, 2-3） at 12 months following dilation （P 〈 0.01 in both）. VAS occurs in a small but significant proportion of patients following radical prostatectomy. NBD offers an effective remedy for VAS.

Salvage Transrectal High-Intensity Focused Ultrasound Therapy for Patients with Recurrence of Vesico-Urethral Anastomosis after Radical Prostatectomy

Background: Salvage radiotherapy has been used as the treatment for patients with local recurrence after radical prostatectomy. However, the therapy is time-consuming and it experiences adverse effects of some kind. Simple and less invasive treatment is highly anticipated. Objectives: To evaluate the outcomes of salvage transrectal high-intensity focused ultrasound (HIFU) therapy for patients with localized recurrence of a vesicourethral anastomosis (VUA) after radical prostatectomy. Material and methods: Sixteen patients with suspected local recurrence of a VUA after prostatectomy were treated with HIFU. All patients had prostate-specific antigen (PSA) failure (>0.2 ng/ml), positive findings of a VUA with biopsy and/or MRI, TRUS and CT, and no distant metastasis by CT, MRI and bone scintigraphy before HIFU. Recurrence after HIFU was determined by PSA failure (>0.2 ng/ml), histological findings, metastasis and start of systemic therapies. Results: HIFU treatments were performed in 16 patients, and followed-up for 7 - 159 months (median 46.5). The pre-HIFU PSA levels ranged from 0.318 to 3.1 ng/ml. Sonication time ranged from 9 - 42 min. All patients had a decline of PSA after HIFU, and 88% of the PSA nadir was Conclusion: HIFU therapy for local recurrence after prostatectomy may become a feasible salvage therapeutic option because of its ease and simple procedure. For salvage HIFU therapy, further research and additional follow-up are required to evaluate and correct the diagnosis of recurrence areas and to provide the sufficient sonication.

Randomized controlled trial comparing open anterograde anatomic radical retropubic prostatectomy with retrograde technique

Objective:Radical prostatectomy is the recommended treatment for localized prostate cancer;however,it is an invasive procedure that can leave serious morbidity.Robot-assisted radical prostatectomy was introduced with the aim of reducing postoperative morbidity and facilitating rapid recovery compared to the traditional Walsh’s open radical retropubic prostatectomy.Therefore,a protocol was developed to perform an open prostatectomy comparable to that performed by robotics,but without involving novel instrumentation.Methods:A total of 220 patients diagnosed with localized prostate cancer underwent radical prostatectomy.They were divided into two groups:anterograde technique(115 patients)and the retrograde method(105 patients).The study outcomes were observed 3 months after surgery.Results:No differences were found in terms of surgical time,hospital stay,and suction drainage.However,reduced bleeding was observed in the anterograde technique(p=0.0003),with rapid anastomosis duration(p=0.005).Among the patients,60.9% undergoing the anterograde technique were continent 3 months after surgery compared to 42.9%treated by the retrograde method(p=0.007).Additionally,fewer complications in terms of the number(p=0.007)and severity(p=0.0006)were observed in the anterograde technique.Conclusion:The anterograde method displayed increased efficiency in reducing complications,compared to the retrograde technique.

Influence of bladder neck suspension stitches on early continence after radical prostatectomy： a prospective randomized study of 180 patients

Several techniques have been introduced to improve early postoperative continence. In this study, we evaluated the impact of bladder neck （vesicourethral anastomosis） suspension on the outcome of extraperitoneal endoscopic radical prostatectomy （EERPE）. In this research, a total of 180 patients underwent EERPE. Group 1 included patients who underwent nerve-sparing EERPE （nsEERPE） （n=45）, and Group 2 included patients who underwent nsEERPE with bladder neck suspension （BNS, n=45）. Groups 3 （n=45） and 4 （n=45） included patients who received EERPE and EERPE with BNS, respectively. Patients were randomly assigned to receive BNS with their nsEERPE or EERPE procedure. Perioperative parameters were recorded, and continence was evaluated by determining the number and weight of absorbent pads （pad weighing test） on the second day after catheter removal and by a questionnaire 3 months postoperatively. Two days after catheter removal, 11.1% of Group 1, 11.1% of Group 2, 4.4% of Group 3 and 8.9% of Group 4 were conti nent. The average urine loss was 80.4, 70.1, 325.0 and 291.3 g for the each of these groups, respectively. At 3 months, 76.5% of Group I and 81.3% of Group 2 were continent. The continence figures for Group 3 and 4 were 48.5% and 43.8%, respectively. Similar overall rates were observed in all groups. In conclusion, although there are controversial reports in the literature, early continence was never observed to be significantly higher in the BNS groups when compared with the non-BNS groups, regardless of the EERPE technique performed.

逆行松解神经血管束且保留Retzius间隙机器人辅助腹腔镜根治性前列腺切除术的技术要点(“大家泌尿网”观看手术视频)

保留耻骨后间隙的前列腺癌根治术(RS-RARP)可以显著提高术后即刻尿控且不增加切缘阳性率。然而该术式学习曲线长,目前能掌握的学者不到10%,尚未推广。基于对前列腺解剖结构及手术方式的认识,本中心对RS-RARP进行优化。我们首创了完全后入路逆行松解神经血管束的RARP,最大限度保留神经血管束,简化手术操作,仅使用一根缝线即可完成尿道吻合,无需使用Hem-o-lok,减少相关并发症。我们在本中心常规开展该术式,通过多维度分析认为这是一种“肿瘤控制可、尿控保护好、性功能恢复快、并发症少、可操作性强”的手术方式。本文详细介绍该术式的关键步骤及操作体会。

腹腔镜下前列腺癌根治术联合保留最大尿道长度和膀胱颈的尿道重建术治疗高危前列腺癌的早期控尿和控瘤效果

目的探讨联合施行保留最大尿道长度(MULP)和膀胱颈(BNP)的尿道重建术与腹腔镜下前列腺癌根治术(LRP)或机器人辅助腹腔镜下前列腺癌根治术(RALP)治疗高危前列腺癌(HRPC)的早期控尿及控瘤效果。方法回顾性分析上海交通大学医学院附属第六人民医院泌尿外科2022年5月—2024年1月收治的23例HRPC患者的临床资料,所有患者均行LRP(包括RALP),并采用联合MULP和BNP的尿道重建技术。收集并分析患者的术前基线资料包括年龄、身体质量指数、临床T分期、Gleason评分、前列腺重量和体积、前列腺特异性抗原;术中变量包括手术方式、手术时间、术中出血量和术中输血患者数;术后变量包括住院时间、尿管留置时间、切缘阳性数、生化复发数、并发症发生率及术后早期尿控率。结果所有患者均顺利完成手术,无中转开放。手术时间(108±31)min,出血量(112±45)mL,无患者术中输血,住院时间(5.5±1.5)d,尿管留置时间(12.6±1.8)d。术后拔除尿管即刻及1、3、6个月的控尿率分别为39.1%、65.2%、73.9%和91.3%。术后2例患者切缘阳性,均为血管神经束切缘。术后无患者出现尿路梗阻或尿瘘等手术相关并发症。结论联合MULP和BNP的尿道重建术在HRPC患者行LRP治疗中可在不增加控瘤风险的前提下,有效提高患者的早期控尿率,改善患者的术后生活质量。

Knotless Laparoscopic Radical Prostatectomy： A Preliminary Experience

INTRODUCTION Radical prostatectomy is the standard for the cure of localized prostate cancer. With the development of laparoscopic and robotic techniques, laparoscopic radical prostatectomy （LRP） or robotic-assisted radical prostatectomy （RARP） has been widely accepted with advantages of less invasiveness, shorter recovery, less blood loss, and better visualization of the operative region compared to open techniques.

改良双手吻合法在腹腔镜下根治性前列腺切除术膀胱尿道吻合中的应用效果

目的探讨改良双手吻合法在腹腔镜下根治性前列腺切除术膀胱尿道吻合中的应用效果。方法回顾性分析2019年9月-2022年9月该科186例应用改良双手吻合法进行手术治疗的前列腺癌患者的临床资料。结果186例患者均成功采用改良双手吻合法,在腹腔镜下根治性前列腺切除术中对膀胱尿道实施吻合处理,术后均未出现严重并发症。膀胱与后尿道吻合手术时间(17±5)min,术后住院时间(7±2)d。目前,186例患者尿控情况恢复均较佳,在病情康复过程中,均未出现吻合口瘘和狭窄等并发症。结论在腹腔镜下根治性前列腺切除术膀胱尿道吻合中,应用改良双后吻合法,用于治疗前列腺癌,效果显著,对机体的创伤相对较小,且安全性高,有利于患者术后快速恢复,值得临床推广应用。

单针双向牵引连续缝合技术在腹腔镜下根治性前列腺切除术中的应用

目的：介绍单针双向牵引连续缝合技术在腹腔镜下根治性前列腺切除术（LRP）中的应用。方法回顾性分析2012年1月至2014年11月42例经腹膜外途径LRP的临床资料。术中采用单针双向牵引连续缝合技术行膀胱尿道吻合。缝合过程中缝合线尾置于体外保持适当张力，从膀胱颈口3点钟处“外进内出”、对应尿道“内进外出”顺时针方向连续缝合，缝合完毕后剪去缝针及多余线尾，充分双向牵引拉紧线头及线尾后打结。记录LRP总手术时间及膀胱尿道吻合时间、引流管及导尿管留置时间，观察并发症以及手术切缘阳性率等指标。结果42例手术均获得成功，术后随访时间2～35（15．2±5．6）个月，因抑郁症术后8月自杀死亡1例，其余患者均存活。LRP总手术时间为105～265（160．5±52．4）min ，膀胱尿道吻合时间为11～27（15．8±4．5）min。膀胱尿道吻合口短暂漏尿3例（6．98％），在随访期间内未发现膀胱尿道吻合口狭窄。切缘阳性6例（13．95％），暂时性尿失禁17例（39．5％），真性尿失禁1例（2．32％）。结论在LRP中，单针双向牵引连续缝合技术能够在有效保证膀胱尿道吻合质量、不增加并发症发生率的前提下，进一步简化吻合操作步骤、缩短手术时间，对于LRP的推广和普及具有较大促进作用。

腹腔镜Sandwich法尿道及周围组织重建改善高风险组前列腺癌根治术后早期尿控的研究

目的探讨腹腔镜Sandwich法尿道及周围组织重建技术对高风险组前列腺癌根治术后早期尿控的疗效。方法纳入2011年1月至2015年9月于本院治疗的高风险前列腺癌患者71例,采用腹腔镜Sandwich法尿道及周围组织重建技术47例,采用单纯尿道吻合技术24例,对比两组患者年龄、体质量指数、前列腺体积、术前前列腺特异性抗原(prostate specific antigen,PSA)、临床分期、手术时间、术后引流管拔除时间、术后尿管拔除时间、病理分期、Gleason评分、术后切缘阳性率、淋巴结阳性率及拔除尿管后第2、4、12、24、52周尿控恢复情况。结果两组患者间年龄、体质量指数、前列腺体积、术前PSA、临床分期、病理分期、Gleason评分、术后切缘阳性率、淋巴结阳性率、术后引流管拔除时间的差异均无统计学意义(P>0.05);Sandwich法尿道及周围组织重建组手术时间长于对照组(P=0.024)、术后尿管拔除时间显著早于对照组(P<0.001),拔除尿管第12周尿控恢复显著优于对照组(P=0.023)。结论腹腔镜Sandwich法尿道及周围组织重建技术安全可行,显著改善高风险组前列腺癌根治术后早期尿控。

机器人辅助腹腔镜前列腺癌根治术后尿道膀胱吻合口狭窄处理及危险因素分析

目的 探讨机器人辅助腹腔镜前列腺癌根治术(RALRP)后尿道膀胱吻合口狭窄(VS)发生的危险因素以及治疗分析.方法 回顾性分析行RALRP的590例患者的临床资料,筛选出RALRP术后2月后发生排尿困难,且经膀胱镜检查确认为VS的患者.采用logistic回归分析患者年龄、体重指数、糖尿病史、术前前列腺特异性抗原(PSA)水平、出血量、Gleason评分、导尿管留置时间、拔除导尿管后尿白细胞计数与VS发生的关系.结果 在590例行RALRP术的患者中,术后2月后共有24例患者发生VS,狭窄发生率为4.06%.导尿管留置时间长和术后尿白细胞计数高是RALRP患者VS的发生的危险因素(OR分别=4.12、5.81,P均<0.05).24例VS患者中,9例行输尿管镜下球囊扩张术;15例行输尿管镜球囊扩张合并膀胱颈口瘢痕电切术,其中6例伴有Hem-o-lok侵蚀尿道膀胱吻合口予以电切周围瘢痕组织后取出.4例术后再次出现排尿困难,间隔2周后多次行尿道扩张术.所有患者经处理后随访半年以上排尿症状均改善.结论 术后留置导尿管时间、拔除导尿管后尿白细胞计数是RALRP术后发生VS的危险因素,对于VS的治疗,初始治疗多采用输尿管镜探查结合尿道扩张,效果确切.

自制引导探子在前列腺癌根治术中引导膀胱尿道吻合19例临床效果观察

目的探讨在前列腺癌根治术中,应用自制的带顶端引导孔的金属尿道探子,引导膀胱尿道吻合的价值。方法 2001年8月至2009年9月行耻骨后前列腺癌根治术患者19例,其中15例保留神经血管束,均应用自制引导探子,于12、2、4、6、8、10点,引导5/8圆针2-0Vicryl线,行膀胱尿道的粘膜外翻间断吻合。结果吻合均顺利完成。吻合操作时间:5～10分钟。2～4周拔出尿管后,排尿通畅,无吻合口狭窄。术后3月内恢复尿控能力6例,12月内恢复尿控能力11例,持续性轻～中度尿失禁2例,1年尿控功能恢复率89.4%。保留神经血管束15例,术后3月内勃起功能恢复2例,12月内勃起功能恢复8例,2例勃起功能减弱,3例不能勃起,1年勃起功能恢复率66.7%。结论应用自制引导探子引导膀胱尿道吻合,操作便捷,缝合精确,可有效保障吻合通畅,减少吻合口狭窄和漏尿,并利于盆底尿控结构及神经血管束的保护。

一项关于机器人辅助腹腔镜下前列腺癌根治术后吻合口尿漏的研究

目的分析机器人辅助腹腔镜下前列腺癌根治术后吻合口尿漏对患者造成的远期影响,并探讨术后吻合口尿漏发生的相关危险因素。方法将2017年4—6月共69例行机器人辅助腹腔镜下根治性前列腺切除术的患者(年龄51~84岁,中位年龄69岁)纳入此次回顾性研究,其中53例患者术后未发生尿漏,归为无尿漏组;另16例患者术后发生尿漏,归为尿漏组。通过电子病历对两组患者的基本资料和术后结果进行收集和统计,并对所有患者行术后随访,随访内容包括:排尿自控情况、国际前列腺症状评分(IPSS)、勃起功能国际问卷(IIEF-5)评分等。结果在术前基本资料中,尿漏组的平均体质指数(BMI)值显著大于无尿漏组(P=0.018)。术后结果方面,尿漏组吻合膀胱尿道的时间显著长于无尿漏组(33.2min vs.29.1min,P=0.004)。且术中尿漏组注水试验失败率(4例,25%)显著高于无尿漏组(2例,3.8%),差异有统计学意义(P=0.023)。尿漏组的住院时间(P<0.001)、术后留置尿管时间(P=0.015)同样显著长于无尿漏组。在平均6.8个月的术后随访中,尿漏组的IPSS评分显著高于无尿漏组(12.5 vs.9.4,P=0.049)。而在排尿自控、勃起功能方面,两组之间的差异无统计学意义。未见患者发生膀胱颈挛缩而需要行膀胱镜检查、尿道扩张等干预。结论机器人辅助腹腔镜下前列腺癌根治术后发生吻合口尿漏对患者远期的排尿自控、勃起功能并无影响。但术后尿漏的患者更易出现程度不一的不良排尿症状。而主刀医生的手术经验和患者自身的吻合难度是影响吻合口尿漏发生的关键因素。

全盆底重建技术在提高腹腔镜前列腺癌根治术后即刻尿控中的应用

目的:探讨一种简化的全盆底重建方法在腹腔镜下前列腺癌根治术中的作用。方法:选取我院在2017年1月至2019年8月期间施行的122例腹膜外腹腔镜下前列腺癌根治术患者,根据术中是否进行盆底重建分为未重建组(57例)和重建组(65例),比较两组手术时间、出血量、淋巴结清扫比例、神经血管束保留情况、尿漏发生率、尿控恢复情况、术后住院天数、腹腔引流管拔除时间及导尿管拔除时间。结果:未重建组与重建组相比,手术时间、出血量、淋巴结清扫比例、神经血管束保留情况、导尿管拔除时间均无统计学差异(P>0.05)。未重建组、重建组的尿漏发生率分别为8.8%vs 0%,两组比较有统计学差异(P<0.05)。拔管即刻、术后1、3、6、12个月尿控率未重建组分别为0%、38.6%、59.6%、78.9%、87.7%,重建组分别为32.3%、56.9%、80%、84.6%、92.3%,两组比较拔管即刻、术后1、3个月有统计学差异(P<0.05),6个月、12个月无统计学差异(P>0.05)。未重建组、重建组的术后住院天数、腹腔引流管拔除时间分别为[(9.1±4.3)d vs(6.7±1.8)d、(6.9±4.5)d vs(4.8±1.5)d],两组比较均有统计学差异(P<0.01)。结论:探索的一种简化的盆底重建方法可提高早期尿控恢复,特别是拔除尿管即刻尿控,降低术后尿漏发生率,从而缩短腹腔引流管留置时间,缩短术后住院天数。

膀胱尿道吻合及重建技术在腹腔镜前列腺癌根治术中的临床体会

目的探讨腹腔镜前列腺癌根治术(laparoscopic radical prostatectomy,LRP)中膀胱尿道吻合及重建技术对降低吻合口并发症的作用。方法回顾性分析27例行LRP的前列腺癌患者临床资料,术中行膀胱颈及前列腺尖部精准游离,经筋膜内分离保留前列腺尖部“帽状”结构,膀胱颈及尿道精细吻合,分期高患者行膀胱颈前后壁重建,观察患者术中情况及术后吻合口尿漏、吻合口狭窄及排尿情况。结果27例患者手术时间114~189 min(平均142.2 min),出血量200~650 mL(平均420 mL),无直肠损伤,术后无引流液48 h内拔除引流管,7~10 d拔除尿管。术后随访3~24个月,无吻合口尿漏,吻合口狭窄1例(3.7%),无肿瘤复发,术后病理分期:pT2期19例,pT3期8例;切缘阳性0例。术后拔除尿管即刻控尿15例(55.56%),术后1个月恢复控尿8例(29.63%),术后3个月恢复控尿3例(11.11%),术后6个月恢复控尿1例(3.7%),无永久性尿失禁。结论腹腔镜前列腺癌根治术中行膀胱颈及尿道精准吻合及膀胱颈重建可有效降低术后尿漏、吻合口狭窄及尿失禁等并发症,值得临床推广。

直视下柱状电极内切开治疗21例前列腺癌根治术后吻合口狭窄的疗效

目的探讨直视下柱状电极内切开治疗前列腺癌根治术后膀胱尿道吻合口狭窄的临床效果。方法回顾性分析2012年3月至2019年6月江南大学附属医院泌尿外科利用等离子柱状电极治疗前列腺癌根治术(RP)后膀胱尿道吻合口狭窄的21例临床资料,比较手术前后最大尿流率、生活质量评分、膀胱残余尿的变化情况。结果本组21例患者手术均成功,其中2例膀胱软镜辅助完成。手术时间(32.0±6.7)(15~70)min,术后3~4周拔除导尿管后排尿通畅,无明显尿失禁。术后3月及12月最大尿流率较术前增加[(19.29±0.94)、(18.95±0.79)mL/s vs.(4.13±0.61)mL/s,P<0.0001];生活质量改善,其评分较术前降低[(2.10±0.54)、(2.00±0.45)分vs.(4.14±0.57)分,P<0.0001];膀胱残余尿降低[(27.86±5.76)、(25.95±5.15)mL vs.(251.14±20.80)mL,P<0.0001]。结论通过柱状电极治疗RP术后膀胱尿道吻合口狭窄疗效确切、安全可行,可作为一种可选择的手术方式,但需进一步随访该术式的更远期疗效。

腹腔镜前列腺癌根治术中不同吻合方法对手术的影响分析

目的:总结两种不同的尿道膀胱颈吻合方法对腹腔镜前列腺癌根治术的影响。方法:2009年1月～2010年3月我科对52例早期局灶性前列腺癌实施经腹膜外腹腔镜前列腺癌根治术,手术采用经腹膜外入路。患者随机分成两组,一组20例采用间断缝合方法,另一组32例采用连续缝合方法。首先将两根15 cm长3-0可吸收肠线末端打结固定,于膀胱颈6点处将两针自膀胱浆膜层向黏膜层穿出,线结位于浆膜层外并拉紧,两针分别向9点、3点方向与尿道吻合,最后在12点处将两线打结,完成吻合。结果:52例腹腔镜前列腺癌根治术均获成功,无一例中转开放手术。间断缝合组:尿道膀胱吻合用时25～41 min,平均32.6 min;出现短时间吻合口漏2例,分别为2天和3天;连续缝合组:尿道膀胱吻合用时11～27 min,平均17.7 min;出现短时间吻合口漏1例,2天后好转。结论:连续缝合方法可缩短手术时间,减少漏尿发生率。

腹腔镜下前列腺根治性切除术中吻合技术对吻合口并发症的影响

目的：比较腹腔镜下前列腺根治性切除术中不同的膀胱尿道吻合方式对吻合口并发症的影响。方法回顾性分析2012年6月至2015年6月诊断为局限性前列腺癌并行腹腔镜下前列腺根治性切除术121例患者的临床资料，根据膀胱尿道吻合方式不同分为两组，采用间断缝合方式36例（间断缝合组），采用连续缝合方式85例（连续缝合组），比较两组手术时间、术后吻合口漏尿、拔管后吻合口狭窄及术后1、3、6个月尿失禁情况的差异。结果121例腹腔镜下前列腺根治性切除术均获成功，无中转开放手术。连续缝合组尿道膀胱吻合时间短于间断缝合组[（20.35±3.10）min比（34.02±3.94）min]，吻合口漏尿发生率[3.53%（3/85）比16.67%（6/36）]、吻合口狭窄发生率[2.35%（2/85）比13.89%（5/36）]、术后1个月尿失禁发生率[15.29%（13/85）比33.33%（12/36）]、术后3个月尿失禁发生率[7.06%（6/85）比25.00%（9/36）]、术后6个月尿失禁发生率[2.35%（2/85）比13.89%（5/36）]均低于间断缝合组，差异有统计学意义（P＜0.05）。结论腹腔镜下前列腺根治性切除术中采用连续缝合的膀胱尿道吻合方式可缩短手术时间，降低吻合口漏尿、吻合口狭窄及尿失禁等并发症的发生。

改良膀胱尿道吻合法在机器人辅助腹腔镜前列腺癌根治术中的应用(附89例报告)

目的:探讨改良膀胱尿道吻合法在机器人辅助腹腔镜前列腺癌根治术(RARP)中的应用价值。方法:2014年9月~2016年9月于我院行RARP的89例患者,均采用双针倒刺自膀胱颈5点和7点连续缝合的改良膀胱尿道吻合法,回顾性分析其临床资料,患者年龄44~81岁,平均68岁;术前PSA 0.03~100ng/ml,平均9.8ng/ml;术前病理诊断腺癌88例,间质肉瘤1例;Gleason评分4~9分,平均7.4分。结果:89例手术均顺利完成,无中转开放。手术时间54~147min,平均89min;术中出血20~600ml,平均178ml;术后下床活动时间1~3d,平均1.5d;住院时间5~29d,平均9d。术后出现漏尿3例、感染1例、肠梗阻2例、尿道狭窄2例,均经保守治疗好转;另有1例切口疝经疝修补好转。术后随访1~23个月,平均9.8个月;术后3、6、12个月完全尿控率分别为86.6%(58/67)、92.7%(51/55)和96.9%(31/32)。7例患者出现生化复发,1例患者出现多发转移,1例患者死亡。结论:应用改良膀胱尿道吻合法行机器人辅助腹腔镜前列腺癌根治术安全可行,可降低术后漏尿发生率,有效改善术后尿控,值得进一步推广。