低频电疗法联合盆底肌锻炼防治机器人辅助腹腔镜下前列腺癌根治术后尿失禁的疗效观察

目的:探讨低频电疗法联合盆底肌功能锻炼对行机器人辅助腹腔镜下前列腺癌根治术患者术后尿失禁(UI)的影响。方法:回顾性分析2017年1月～2018年6月在我院接受机器人辅助腹腔镜下前列腺癌根治术治疗的48例患者的临床资料,将予以常规护理的24例患者为对照组,在常规护理的基础上同时予以低频电子脉冲膀胱治疗仪联合盆底肌功能锻炼法辅助治疗的24例患者为观察组。结果:观察组患者术后早期UI的发生率明显低于对照组(37.5%vs.66.7%,P0.05),其恢复期3个月内尿控率明显高于对照组,差异有统计学意义(P0.05)。结论:对接受机器人辅助腹腔镜下前列腺癌根治术的患者行低频电疗法联合盆底肌功能锻炼可显著降低术后早期UI的发生率,提高恢复期控尿率,并可促进患者控尿功能的恢复。     

早期康复训练在预防腹腔镜前列腺癌根治术后尿失禁的应用研究

目的 探讨早期康复训练对预防腹腔镜前列腺癌根治术后尿失禁的应用效果.方法 将100例拟行腹腔镜前列腺癌根治术患者随机分成观察组和对照组各50例,观察组实施早期康复训练,术前及术后早期均进行提肛训练;对照组实施常规护理,仅在术后进行提肛训练.比较两组患者术后拔除尿管后尿失禁发生率、尿控功能恢复时间以及观察组术前不同提肛训练时间与术后尿失禁发生率的关系.结果 观察组术后尿失禁发生率、尿控功能恢复时间均明显低于对照组(P＜0.05);不同术前提肛训练时间尿失禁发生率比较差异无统计学意义(P＞0.05).结论 早期康复训练有助于预防腹腔前列腺癌根治术后尿失禁的发生,缩短尿控功能恢复时间.     

综合护理干预对前列腺癌根治术后尿失禁影响的研究

目的 探讨综合护理干预措施对前列腺癌根治术后尿失禁的影响.方法 将25 例前列腺癌根治术后尿失禁的患者随机分为常规护理组(对照组)和综合护理组(观察组),观察组在常规护理的基础上,采取盆底肌训练、排尿反射训练、膀胱功能训练、盆底电刺激及生物反馈治疗等一系列的护理干预措施,观察两组患者于尿管拔除后半年内的尿失禁恢复情况.结果 观察组尿失禁的恢复时间比对照组明显缩短,护理干预效果的有效率高于对照组.两组比较,差异显著,有统计意义.结论 对前列腺癌根治术后尿失禁的患者,应采取综合护理干预措施,改善尿失禁情况,使患者早日恢复控尿功能,提高患者的生活质量.     

负压治疗联合盆底肌训练对前列腺癌根治术后患者控尿功能及性功能的影响

目的探讨负压治疗联合盆底肌训练对前列腺癌根治术后患者控尿功能及主观幸福感的影响。方法将中山大学附属第三医院2016年10月至2019年4月泌尿外科确诊为前列腺癌并行腹腔镜下前列腺癌根治术治疗的70例患者,按随机数字表法分为干预组和对照组各35例,其中对照组35例采用常规护理(盆底肌功能锻炼),干预组35例在常规护理基础上,术后6周起再增加负压治疗。比较对照组和干预组术后6周、10周、18周控尿功能恢复情况,同时进行国际勃起功能评分表(IIEF-5)评分及主观幸福感调查,观察其治疗效果。结果干预组术后6周、10周、18周尿失禁评分中位值分别2分、1分与0分,低于对照组的2分、2分与2分,提示干预组术后平均控尿功能恢复时间较对照组短,差异有统计学意义(P<0.05);此外干预组相比对照组,IIEF-5评分及主观幸福感评分上升速度较快,提示干预组术后勃起功能和生活质量改善情况明显优于对照组。结论负压治疗联合盆底肌训练对前列腺癌根治术后患者的控尿功能和性功能有明显改善,且缩短其恢复时间。     

即时尿控前列腺癌根治术——精准解剖的10年探索与实践(附编者按)王行环

前列腺根治性切除术是局限性前列腺癌的标准治疗方式。然而,尿失禁是该根治术后最常见的并发症之一,也是影响患者术后生活质量最重要的因素。本文描述了笔者首创的一种基于对盆底及前列腺周围组织精细解剖的新技术——即时尿控前列腺癌根治术,在不影响肿瘤学结局的前提下,显著加速患者尿控功能的康复,使得即时尿控成为可能。     

女性压力性尿失禁术后患者行盆底肌肉锻炼的控尿效果观察

目的探讨女性压力性尿失禁术后患者行盆底肌肉锻炼的效果。方法回顾性分析医院100例轻、中度压力性尿失禁患者临床治疗情况,其中以常规药物治疗者为对照组,50例;行盆底肌肉锻炼者为观察组,50例。评价两组治疗前后排尿状况和盆底肌力评分,记录两组控尿效果(漏尿量、漏尿程度、漏尿次数)。根据患者治疗状况以问卷形式调查患者治疗效果。结果两组患者治疗后排尿状况评分较治疗前显著下降,观察组下降更显著,而盆底肌力评分明显升高,观察组升高程度显著,P0.05。观察组漏尿次数、漏尿量,明显少于对照组,且漏尿程度低于对照组,P0.05。观察组患者主观疗效明显优于对照组,P0.05。结论女性压力性尿失禁患者术后行盆底肌肉锻炼可通过提高患者盆底肌力来起到较好的控尿效果,值得推荐。     

围手术期康复训练预防腹腔镜前列腺癌根治术后尿失禁

腹腔镜前列腺癌根治术是当前治疗局限性前列腺癌常用的手术方式,尽管腔镜下对前列腺周围解剖较开放手术更精细,但其术后仍有尿失禁发生[1]。据报道腹腔镜前列腺癌根治术后尿失禁发生率高达2％~86％[2]。众所周知,术后尿失禁不仅严重影响患者生活质量及心理健康,而且可能降低患者接受手术治疗的意愿[3]。为有效降低腹腔镜前列腺癌根治术后患者尿失禁的发生率,促进术后控尿功能早期恢复,湖北省肿瘤医院泌尿外科于2012年6月至2015年12月间对腹腔镜前列腺癌手术患者采用围手术期康复训练,明显降低了术后尿失禁的发生率。现报告如下。     

最长尿道长度保存对腹腔镜前列腺癌根治术后尽快恢复尿控的意义研究

目的:研究最长尿道长度保存(maximal urethral length preservation,MULP)对腹腔镜前列腺癌根治术后尽快恢复尿控的临床意义。方法:回顾性分析我院2013年2月~2015年3月80例行腹腔镜前列腺癌根治术的临床资料,随访至2016年3月。其中40例进行MULP腹腔镜前列腺癌根治术患者为治疗组,另外40例非行MULP腹腔镜前列腺癌根治术患者为对照组,在手术前两组患者年龄、平均BMI、既往史(糖尿病)、术前NHT、前列腺体积、术前前列腺特异性抗原(PSA)、术前Gleason评分、术前病理T分期均无统计学意义(P0.05)。比较治疗组与对照组手术时间、切缘阳性率、前列腺尖部切缘阳性率、术后PSA(ng/ml)、术后Gleason评分、并发症率及两组患者术后1、3、6、12个月尿控恢复情况、国际尿失禁咨询委员会尿失禁问卷表简表(ICI-QSF)评分情况。结果:两组患者手术都成功完成,两组术后3、6、12个月并发症发生率、切缘阳性率、前列腺尖部切缘阳性率及PSA0.2ng/ml的比率差异均无统计学意义(P0.05)。两组术后1、3个月尿控恢复人数和ICIQ-SF评分情况差异均有统计学意义(P0.05);术后6、12个月的尿控恢复人数和ICI-Q-SF评分情况差异均无统计学意义(P0.05)。结论:行MULP的腹腔镜前列腺癌根治术有利于术后早期尽快恢复尿控,且不增加切缘阳性率。     

加速康复外科理念在日间病房胆囊切除术的应用

目的 探讨融合加速康复外科理念的日间病房护理对腹腔镜下胆囊切除术患者术后康复的影响。方法 将102行腹腔镜胆囊切除术的患者随机分为两组,即对照组51例,开展围术期常规护理;观察组51例,开展融合加速康复外科理念的日间病房护理,评估两组术后康复效果。结果 观察组术后3 h、6 h、24 h的VAS评分比对照组低（P<0.05）;术后肠鸣音恢复时间（10.90±1.98） h、首次肛门排气时间（15.30±2.30） h,进食时间（19.09±3.10） h及下床活动时间（7.99±1.34） h均比对照组短（P<0.05）;并发症发生率为1.96%,略低于对照组9.80%(P>0.05)。结论 给予腔镜下胆囊切除术患者融合加速康复外科理念的日间病房护理,既能减轻患者疼痛,又能促进患者康复。     

前列腺癌行机器人腹腔镜根治术后的精细护理

目的探讨精细护理运用于机器人腹腔镜前列腺癌根治术后患者对其排尿功能、膈下疼痛的影响。方法将78例前列腺癌行机器人腹腔镜根治术患者按时间段分为对照组和观察组各39例,对照组术后行常规护理,观察组实施精细护理。结果观察组术后24~48h膈下疼痛评分显著少于对照组、排尿功能改善程度显著优于对照组,带管出院率及尿管留置时间显著低于和少于对照组(P0.05,P0.01)。结论对前列腺癌行机器人腹腔镜根治术后患者实施精细护理,有利于术后症状改善及膀胱功能恢复。     

Reconsideration of pelvic floor muscle training to prevent and treat incontinence after radical prostatectomy

Urinary incontinence is common after radical prostatectomy. Pelvic floor muscle training provides a plausible solution. Although early trials provided promising results, systematic reviews have questioned the efficacy of this intervention. A major consideration is that most clinical trials in men have applied principles developed for pelvic floor muscle training for stress urinary incontinence in women, despite differences in anatomy between sexes and differences in the mechanisms for continence/incontinence. Literature regarding continence control in men has been conflicting and often based on erroneous anatomy. New understanding of continence mechanisms in men, including the complex contribution of multiple layers of striated pelvic floor muscles, and detailed consideration of the impact of radical prostatectomy on continence anatomy and physiology, have provided foundations for a new approach to pelvic floor muscle training to prevent and treat incontinence after prostatectomy. An approach to training can be designed to target the pathophysiology of incontinence. This approach relies on principles of motor learning and exercise physiology, in a manner that is tailored to the individual patient. The aims of this review are to consider new understanding of continence control in men, the mechanisms for incontinence after radical prostatectomy, and to review the characteristics of a pelvic floor muscle training program designed to specifically target recovery of continence after prostatectomy.     

前列腺癌根治术后电针联合提肛训练对改善尿控的研究

目的 探讨电针辅助提肛锻炼对前列腺癌根治术后患者尿失禁治疗的效果和意义.方法 2008年9月至2009年9月接受前列腺癌根治术并完整随访的患者109例,年龄48～79岁.按照术前患者意愿分为两组:治疗组40例,拔除导尿管1周后,在提肛锻炼的同时加用电针辅助治疗;对照组69例,术后只应用提肛锻炼帮助尿控恢复.随访术后尿控情况,记录相关临床特征,进行ICI-Q-SF量表评分,并进行相关统计学分析.结果 治疗组和对照组尿控曲线差异具有统计学意义(P=0.029).两组尿控率差异从术后4周起逐渐明显,至术后6周差异最大(P=0.023),其后差异逐渐缩小,至术后16周基本无差异.ICI-Q-SF评分量表显示的两组患者主观尿失禁感受也与尿控率情况相符合.结论 前列腺癌根治术后电针辅助提肛锻炼可以明显缩短患者尿控恢复时间.     

Evaluation of pelvic floor muscle strength before and after robotic-assisted radical prostatectomy and early outcomes on urinary continence

The aim of the study was to evaluate the effect of pelvic floor muscle (PFM) assessment and training before and after robot-assisted laparoscopic radical prostatectomy (RARP) in improving PFM strength and urinary continence. We performed an analysis of a database of patients who underwent robot-assisted laparoscopic radical prostatectomy (RARP) performed by two urologists from 2011 to 2013. Pelvic floor muscle (PFM) activation and strength were graded by a trained pelvic floor physiotherapist. Patients were given an exercise program, grouped according to the strength of their pelvic floor as graded by assessment, to complete before and after surgery. PFM strength was recorded preoperatively, 4 days post-catheter removal and 4 weeks post-catheter removal. Continence was recorded at 4 weeks postop and was defined as the requirement of no continence aids. A total of 98 patients had RARP and a preoperative physiotherapy assessment plus postoperative appointments at around 1 and 4 weeks post-RARP. The majority of men improved their PFM strength regardless of preoperative strength with no significant predictors of postoperative strength found. Age was the only significant predictor of postoperative incontinence. In this pilot study, a majority of patients increased their pelvic floor strength with time. Pelvic floor physiotherapy is an important modifiable patient factor, which does have an impact in improving patients’ urinary continence by strengthening the pelvic floor muscles. Patient age influences response to pelvic floor physiotherapy.     

加速康复外科策略与常规策略在腹腔镜前列腺癌根治术中的效价比较

目的探讨基于多模式镇痛的加速康复外科（ERAS）理念应用于腹腔镜前列腺癌根治术中的优势。 方法回顾性分析2017年1月至12月我院同一组手术医师行腹腔镜下前列腺癌根治术患者围术期的相关资料,ERAS组患者11例,常规策略组患者24例。 结果两组患者年龄,ASA分级及心功能分级差异无统计学意义。ERAS组患者较常规治疗组术中补液量降低[（7.2±2.2）ml vs（10.7±3.8）ml/kg/h,P=0.009],术后住院时间明显减少[（7.5±2.8）d vs（10.3±2.8）d,P=0.008],术后首次排气时间缩短[（1.4±0.9）d vs（2.4±0.9）d,P=0.018]。ERAS组住院总费用及麻醉费用均较对照组增加[（75 129±21 217）元vs（55 201±19 109）元,P=0.009;（5 537±4 430） 元vs（3 121±726）元,P=0.01],而在总住院时间、麻醉费用所占住院总费用比例方面,两组差异无统计学意义。 结论在腹腔镜前列腺癌根治术中应用ERAS理念下多模式镇痛,可以加速患者胃肠道功能恢复,缩短术后住院时间,不增加围术期并发症的发生率。     

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.     

阴道锥体训练联合生物反馈盆底肌治疗尿失禁老年人盆底肌康复研究现状

目的研究阴道锥体训练联合生物反馈盆底肌治疗尿失禁老年人的临床疗效及对盆底肌的影响。方法选取84例从2016年9月至2018年3月本院收治的尿失禁老年患者进行研究,以随机抽签法将其均分为联合组及对照组,每组42例。对照组予以常规盆底肌训练治疗,联合组则予以阴道锥体训练联合生物反馈盆底肌治疗。对比两组在临床疗效、治疗前后盆底肌力情况、治疗前后尿动力学参数指标水平以及生活质量变化情况等方面的差异。结果联合组与对照组在总有效率方面比较,前者高于后者(P<0.05)。治疗后联合组盆底肌力分级为Ⅳ级、Ⅴ级的人数占比相比对照组较高(P<0.05)。治疗后联合组与对照组在VLPP、PMUC水平方面比较,前者高于后者(P<0.05)。治疗后联合组与对照组I-QOL评分相比治疗前较高,且联合组相比对照组较高(P<0.05)。结论阴道锥体训练联合生物反馈盆底肌治疗老年尿失禁患者的疗效显著,有利于促进盆底肌力的恢复,且有效改善患者尿动力学参数,提高生活质量,具有较高的临床推广应用价值。     

Posterior musculofascial plate reconstruction promotes early restoration of continence and prevents severe incontinence in patients undergoing laparoscopic radical prostatectomy

The objective of the present study was to assess the efficacy of posterior reconstruction of Denonvilliers' musculofascial plate for restoring urinary continence after laparoscopic radical prostatectomy. A total of 48 consecutive patients who underwent laparoscopic radical prostatectomy were retrospectively reviewed. Of them, 23 underwent laparoscopic radical prostatectomy without posterior reconstruction of Denonvilliers' musculofascial plate (group 1) and 25 underwent laparoscopic radical prostatectomy with posterior reconstruction of Denonvilliers' musculofascial plate (group 2). Patients' demographics were analyzed and continence rates between the two groups at 1, 3, 6 and 12 months after surgery were compared. Patients in group 2 had significantly larger prostates than in group 1. There were no significant differences between the two groups in terms of the other patient characteristics. The urinary continence rates were significantly higher in group 2 than in group 1 at 1, 3 and 12 months after surgery, and the rates of severe incontinence were significantly lower in group 2 at all time‐points considered. These findings suggest that posterior reconstruction of Denonvilliers' musculofascial plate helps in restoring early continence and decreasing severe incontinence in patients undergoing laparoscopic radical prostatectomy.     

盆底肌锻炼在女性压力性尿失禁患者中的应用价值

目的：探讨盆底肌锻炼在女性压力性尿失禁患者中的应用价值。方法选择2011年3月-2013年3月我院接诊的80例女性压力性尿失禁患者进行研究。按照随机数字表法,随机分为观察组和对照组。对照组采用常规的体操锻炼对患者进行治疗,观察组采用新式的盆底肌锻炼对患者进行治疗。观察记录两组患者治疗前后的肌力状况,治疗前后漏尿量及尿垫试验的结果,并采用治疗后的临床疗效评价标准对两组患者治疗临床疗效进行比较分析。结果两组患者治疗后肌力均明显增高（P＜0.01）,治疗后观察组肌力明显高于对照组（P＜0.01）;治疗后,观察组患者的肌力分度明显优于对照组,两组比较差异有统计学意义（u=-2.4795,P=0.0132）。观察组患者的漏尿量明显少于对照组（P＜0.01）,治疗后3、6及12个月后,患者尿垫试验阳性率明显低于对照组（P＜0.05）。治疗总有效率（97.5%）明显高于对照组（72.5%）,两组比较差异有统计学意义（u=-2.9441,P=0.0032）。结论盆底肌锻炼在女性压力性尿失禁患者中的应用价值较高,值得临床推广应用。     

Impact of early pelvic floor rehabilitation after transurethral resection of the prostate

We examined the results of teaching pelvic floor muscle exercises (PME) on micturition parameters, urinary incontinence, post-micturition dribbling, and quality of life in patients after transurethral prostatectomy (TURP). Fifty-eight consecutive patients who were selected to undergo TURP for benign prostatic hyperplasia (BPH) were admitted into the study: 28 were randomly assigned to a control group (A), 30 formed the investigational group (B) during an initial visit conducted before surgery. In group B patients, perineal exercises were demonstrated in detail, and tested for their correct use via simultaneous rectal and abdominal examination. After the removal of the urethral catheter, these patients were instructed to perform pelvic floor muscle exercises at home and were evaluated before the exercises and at weekly intervals postoperatively. The American Urological Association Symptom Score improved significantly after TURP in both groups. The average quality of life score improved more significantly in group B after TURP, from 5.5 to 1.5 (P < 0.001). The grade of muscle contraction strength after 4 weeks of PME increased from 2.8 to 3.8 in group B (P < 0.01); it was unchanged in the group A. The number of patients with incontinence episodes and post-micturition dribbling was significantly lower in the group B at weeks 1, 2, and 3 (P < 0.01). Our results show that pelvic floor muscle re-education produces a quicker improvement of urinary symptoms and of quality of life in patients after TURP. Its early practice reduces urinary incontinence and post-micturition dribbling in the first postoperative weeks. The exercises are simple and easy to perform in the clinical setting and at home, and therefore should be recommended to all cooperative patients after TURP.