盆底筋膜保护与重建对腹腔镜下前列腺癌根治术后早期控尿的影响

目的：了解采用盆底筋膜保护与重建法对腹腔镜下前列腺癌根治术后患者早期控尿的影响.方法回顾性分析自同一术者2013年1月至2015年12月在广东省中医院泌尿外科行腹腔镜下前列腺癌根治术的40例患者资料，其中采用盆底筋膜保护与重建技术的前列腺癌患者17例(治疗组)，采用常规腹腔镜下治疗的前列腺癌患者23例(对照组)，对两组患者的年龄、术前BMI、术前前列腺体积、术前临床分期、术前 Gleason 评分、手术时间、术中出血量、术后吻合口漏尿率、术后病理切缘阳性率、术后病理分期、术后 Gleason 评分及早期尿控功能恢复的情况等临床指标进行统计学分析.结果40例腹腔镜下前列腺癌根治术均经腹膜外完成，术中无中转开放，无术中输血病例，术后吻合口无漏尿，两组均有1例术后病理切缘阳性.两组在年龄、术前 BMI、术前前列腺体积、术前临床分期、术前 Gleason 评分、手术时间、术中出血量、术后病理分期及术后 Gleason评分方面差异均无统计学意义(P ＞0．05)；40例患者均在术后12~16 d 拔除尿管，治疗组拔除尿管后3 d 内、1个月内和3个月内的累积完全控尿比例分别为52．9％、64．7％和82．4％，显著高于对照组(分别为8．7％、26．1％和34．8％)，两组差异有统计学意义(P ＜0．05).结论在腹腔镜前列腺癌根治术中使用盆底筋膜保护与重建技术可显著提高患者术后早期的控尿能力.

The effectiveness of pelvic fascia protection and reconstruction on early urinary continence in laparo-scopic radical prostatectomy

Objective To study the effectiveness of pelvic fascia protection and reconstruction on early urinary continence in laparoscopic radical prostatectomy. Methods We performed a retro-spective analysis of 40 patients who accept laparoscopic radical prostatectomy in Urology Department of Guangdong Hospital of Traditional Chinese Medicine from January 2013 to December 201 5.1 7 pa-tients with pelvic fascia protection and reconstruction in laparoscopic radical prostatectomy and 23 patients with conventional laparoscopic radical prostatectomy were compared by age,pre-operation BMI,pre-operation prostate volume,preoperative clinical stages,preoperative Gleason score,opera-tion time,intraoperative blood loss volume,postoperative anastomotic leakage rate,postoperative pathological margin positive rate,postoperative pathological stage,Gleason score and early recovery of urinary control. Results Forty extra peritoneal laparoscopic radical prostatectomy cases were completed without open conversion,intraoperative blood transfusion, postoperative anastomotic leakage,postoperatively pathological positive margin.Both groups had one case of positive margin. There were no statistical significances in age,pre-operation BMI,pre-operation prostate volume,op-eration time,intraoperative blood loss volume,postoperative pathological stage and postoperative Gleason score between two groups (P < 0.05 ).All forty cases removed urinary catheters at 12-1 7 days postoperatively.There were statistically significant differences between two groups in complete urinary control rates after removing urinary catheters of 52.9% in 3 days,64.7% in 1 month and 82.4% in 3 months in obser-vation group,which were significantly higher than control group 8.7% in 3 days,26.1% in 1 month and 34.8% in 3 months (P <0.05 ). Conclusions Pelvic fascia protection and reconstruction in laparoscopic radical prostatectomy can significantly improve patients’early urinary control capacity.