腹腔镜前列腺癌根治术中两种膀胱尿道吻合方法的比较研究

目的:比较腹腔镜前列腺癌根治术中两种膀胱尿道吻合方法的患者临床资料,探讨单针体外牵拉缝合方法的效果。方法:回顾性分析95例接受经腹膜外腹腔镜前列腺癌根治术患者的临床资料。根据膀胱尿道吻合方法分为两组;双针连续缝合法组(A组,n=52)和单针体外牵拉缝合法组(B组,n=43)。分别比较两组手术时间、膀胱尿道吻合时间;引流管留置时间、导尿管留置时间、并发症以及手术切缘等指标。结果:与A组相比,B组有较短的手术时间(A组179.9min,B组142.8min,P<0.05)、膀胱尿道缝合时间(A组22.0min,B组12.9min,P<0.05);和较低的吻合口漏尿发生率(A组15.4%,B组2.3%,P<0.05)。但在术后尿道狭窄发生率、引流管留置时间、导尿管留置时间以及手术切缘阳性率等方面两组并无明显差异。结论:腹腔镜前列腺癌根治术中采用单针体外牵引缝合法可以缩短膀胱尿道吻合时间以及总手术时间,同时可以减少吻合口漏尿发生率。     

改良食管胃吻合方法的临床应用

目的 预防食管、贲门癌手术后吻合口瘘和吻合口狭窄的发生。方法 将３５８例食管、贲门癌患者随机分为两组,研究组和对照组。研究组：１７８例采用可吸收缝合线做单层（全层）连续吻合,并用带蒂大网膜包绕吻合口;对照组：１８０例常规食管胃丝线间断缝合加食管壁与胃壁包裹。结果 术后研究组无１例发生吻合口瘘和严重的吻合口狭窄,对照组发生吻合口瘘５例（２．７８％）,发生严重吻合口狭窄６例（３．３３％）;两组比较有差     

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例采用问断缝合方法。另一组32例采用连续缝合方法。首先将两根15cm长3-0可吸收肠线末端打结固定。予膀胱颈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25～41min,平均32．6min;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11～27min,平均17．7min;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。     

机器人辅助的腹腔镜下前列腺癌根治术中三种膀胱颈-尿道吻合法的比较

目的在开展机器人辅助的腹腔镜下前列腺癌根治术（RALP）初期,尝试不同的膀胱颈．尿道吻合方法,以期规范化、模式化RALP术式,并缩短本术式的学习曲线。方法2012年4月至2013年8月,由单一术者实施机器人辅助的腹腔镜下前列腺癌根治术40例。40例RALP术均经腹腔途径实施,术中膀胱颈．尿道吻合步骤分别应用以下三种方法：（1）自钟面3点或9点位进针,单针连续缝合（A组,n=17）;（2）自钟面5点至7点进针,自制双针连续缝合（B组,n=5）;（3）自钟面5点和7点进针,Quill免打结倒刺缝线连续缝合（C组,n=18）。分别比较三组的吻合时间、引流管留置时间及术后吻合口相关并发症发生情况等指标;并由术者和第一助手分别主观评估三种技术的难度。结果40例RALP手术均获成功,无一例中转开放手术。膀胱颈．尿道吻合的中位时间在各组间分别为：A组18min（14-42min）,B组17min（13-35min）,C组12min（10-25min）,C组较A、B组有效地减少了吻合时间（P〈0．05）,而在吻合相关并发症发生率上三组差异无统计学意义。经由术者主观评估,三种技术难度由A、C、B依次递减,经由第一助手评估,三种术式的配合技术中单针吻合即A组难度最大,B组其次,C组最易掌握。结论在机器人辅助的腹腔镜下前列腺癌根治术中,不同的吻合技术对获得吻合口的密闭性的效果相当,单针吻合可获得更为平整的吻合口后壁,双针吻合法难度较小且更易对抗吻合断端张力,Quill倒刺缝线操作配合最为简便且能有效缩短吻合时间。     

减少术后尿失禁及尿道狭窄的列腺癌根治术（附42 例报告）

目的：探讨减少前列腺癌根治术后尿道狭窄及尿失禁的术式。方法：采用膀胱颈粘膜外翻固定再与尿道对端吻合及保留膀胱颈环状肌纤维的前列腺癌根治术治疗前列腺癌42例。结果：42例术后均发生膀胱尿道吻合口狭窄，尿失禁2例。随诊4－70个月，最大尿流率25．0－30．7ml/s。结论：采用膀胱颈粘膜外翻固定再与尿道对端吻合及保留膀胱颈环肌纤维的前列腺癌根治术，术后避免或减少了尿道狭窄，减低尿失禁的发生。     

食管重建中食管胃吻合术式的改进（附65例分析）

在65例食管癌、贲门癌手术治疗中,对吻合口的处理采用食管胃“两定点吻合”加半边大网膜覆盖。作为术式改进组;另对50例食管癌,贲门癌采用传统吻合方式,将肌层行间断缝合包埋,作为对照组。两组患者在性别,年龄、病灶的病理分类等方面无明显差异。比较两组的吻合口瘘和吻合口狭窄的发生率,术式改进组未发生吻合口瘘和吻合口狭窄;对照组发生吻合口瘘1例。发生吻合口狭窄4例。食管重建中,对吻合口的操作采用食管胃“两定点吻合法”能有效地避免和减少吻合口瘘及吻合口狭窄的发生。     

减少术后尿失禁及尿道狭窄的前列腺癌根治术(附42例报告)

目的探讨减少前列腺癌根治术后尿道狭窄及尿失禁的术式. 方法采用膀胱颈粘膜外翻固定再与尿道对端吻合及保留膀胱颈环状肌纤维的前列腺癌根治术治疗前列腺癌42例. 结果 42例术后均未发生膀胱尿道吻合口狭窄,尿失禁2例.随诊4～70个月,最大尿流率25.0～30.7 ml/s. 结论采用膀胱颈粘膜外翻固定再与尿道对端吻合及保留膀胱颈环状肌纤维的前列腺癌根治术,术后避免或减少了尿道狭窄,减低尿失禁的发生.     

腹腔镜前列腺癌根治术中采用膀胱颈口荷包缝合联合尿道周围组织重建的早期尿控效果北大核心CSCD

目的探讨腹腔镜前列腺癌根治术中采用膀胱颈口荷包缝合联合尿道周围组织重建的早期尿控效果。方法2020年2月~2021年4月我们在20例腹腔镜前列腺癌根治术中采用膀胱颈口荷包缝合联合尿道周围组织重建。尿道后壁重建:将狄氏筋膜残端与尿道括约肌后壁中线结构缝合,再缝合至膀胱颈后壁筋膜;膀胱颈口荷包缝合及尿道吻合:将膀胱颈口肌层做连续荷包缝合,端端吻合膀胱颈及尿道;尿道前壁重建:将耻骨前列腺韧带与膀胱前壁连续缝合、悬吊尿道。结果20例手术均顺利完成,无中转开放或其他术式。手术时间(200.0±54.9)min,术中出血量(44.3±19.8)ml,术后住院时间(8.9±2.8)d,引流管留置时间(7.6±2.7)d,导尿管留置时间(12.9±2.6)d。术后病理:T2a期1例,T2b期4例,T2c期7例,T3a期5例,T3b期3例;术后标本病理Gleason评分:6分1例,7分9例,8分4例,9分5例,10分1例;切缘阳性率10%(2/20)。拔除导尿管后即刻和术后1、3、6个月尿控良好率分别为70%(14/20)、85%(17/20)、95%(19/20)、100%(20/20)。结论腹腔镜前列腺癌根治术中采用膀胱颈口荷包缝合联合尿道周围组织重建安全、可行,操作容易,患者术后早期尿控恢复满意。     

经腹膜外腹腔镜前列腺癌根治术的关键点及操作技巧（附33例报告）

目的：总结经腹膜外腹腔镜前列腺癌根治术治疗前列腺癌的手术经验和操作技巧.方法：2006年1月～2010年3月对33例前列腺癌患者行经腹膜外腹腔镜前列腺癌根治术,手术经腹膜外顺行路径切除前列腺,切开膀胱颈部前先以1-0可吸收线缝扎背血管复合体,采用单针连续吻合法进行膀胱与尿道的吻合.结果：33例手术均获得成功,无中转开放手术.手术时间120～575 min,平均234 min,术中出血量100～1500 ml,平均320 ml,术后48小时内胃肠功能恢复,术后1～2天下地活动,没有直肠损伤和吻合口尿漏出现.标本切缘阳性1例.2例术后出现轻度尿失禁.2例出现尿道狭窄.对其中31例患者随访3～51个月,未发现肿瘤局部和生化复发和远处转移;术后3个月前列腺特异性抗原0～0.1 μg/L.结论：经腹膜外腹腔镜前列腺癌根治术是一种安全有效的手术方法.熟悉前列腺局部解剖及熟练掌握各种腹腔镜下操作技术是手术成功的关键.     

腹腔镜前列腺癌根治术后并发症的护理

对26例前列腺癌患者行腹腔镜下经腹途径前列腺癌根治术。术后8例发生尿外渗，2例尿失禁，2例尿道膀胱吻合口狭窄，6例性功能障碍。经对症处理均治愈或好转，其护理主要有保持尿管引流通畅，盆底肌训练，针对性心理护理等措施。     

Radical retropubic prostatectomy with running vesicourethral anastomosis and early catheter removal: Our experience

Objectives:   To assess the outcomes of patients undergoing radical retropubic prostatectomy (RRP) with a running vesicourethral anastomosis and catheter removal on postoperative day 3 or 5.
Methods:   From February 2006 through December 2007, 55 patients underwent RRP at our institution. All procedures were performed by a single surgeon using a running suture for the vesicourethral anastomosis. A cystogram was carried out before catheter removal in all patients. The initial 23 of 55 patients (Group 1; n  = 23) had the cystogram on postoperative day 5, the other 32 patients (Group 2; n  = 32) had the cystogram on postoperative day 3. Removal of the catheter was only carried out if there was no anastomotic extravasation.
Results:   The success rate of catheter removal in group 1 and 2 was 100% and 96.9%, respectively. Overall continence rates were 83.3%, 87% and 90.7% at 24, 48 and 72 h after removal of the catheter, respectively. There was no significant difference in terms of continence rate between groups 1 and 2. None of the patients had acute urinary retention and/or anastomotic stricture after catheter removal.
Conclusions:   These findings suggest that an advanced running vesicourethral anastomosis during RRP is technically feasible, allowing safe early catheter removal in most patients.     

Analysis of three different vesicourethral anastomotic techniques in laparoscopic radical prostatectomy

Objectives  The vesicourethral anastomosis is critical to the outcome of laparoscopic radical prostatectomy (LRP). We retrospectively compared a recently introduced running suture with existing interrupted techniques. Materials and methods  A total of 600 patients undergoing LRP at our institution were reviewed. Each group consisted of 200 patients. Group 1 (intracorporeal-single-knot-running suture) was compared to cohorts in whom the anastomosis was created by interrupted suturing, with (group 2) or without (group 3) a previously placed 6 o’clock suture. Intraoperative data and cystographic evaluation were collected prospectively. Detailed analysis of the location of extravasation was correlated with duration of leak. At a median follow up of 26 months, continence and stricture rates were assessed. Results  The groups were statistically similar with respect to age, prostate volumes and pre-operative PSA. Numbers of patients undergoing lymphadenectomy and/or nerve-sparing procedures were also similar between groups. The median time for anastomosis was significantly shorter for group 1 (15.3 min) compared to group 2 (23.5 min) and group 3 (27.7 min) (P < 0.000.1). This was reflected in the overall operative times [group 1; 155.4 min, group 2; 185.6 min and group 3; 202.2 min (P = 0.03)]. Subjective assessment suggested that tension to the anastamosis was present in fewer patients in group 1 (3.5%) compared to group 2 (17%) and group 3 (9.5%) (P = 0.001). There was no significant difference in the continence or stricture rate between the three groups. Conclusions  The continuous anastomotic suture reduced the operative time and tension to the anastomosis. However, the long term continence and stricture rates were unaffected by anastomotic technique.     

Vesicourethral anastomotic strictures after radical retropubic prostatectomy: the experience of a single institution

OBJECTIVE: Stricture of the vesicourethral anastomosis remains a well-documented complication after radical retropubic prostatectomy. MATERIALS AND METHODS: We performed a retrospective study of 294 patients with prostate cancer who underwent radical retropubic prostatectomy. Possible correlations between anastomotic stricture formation, tumor stage, positive surgical margins, number of anastomotic sutures, bladder neck preservation, urine leakage, previous prostate surgery and/or intraoperative blood loss were examined. RESULTS: An anastomotic stricture was found in 18 cases (6%) requiring some kind of treatment. In 10 patients (56%), the bladder neck stricture occurred within 3 months after surgery, in 5 (28%) at 4-12 months after surgery and in 3 (16%) more than 12 months after surgery. Intraoperative blood loss (>1,000 ml) was found to be significantly correlated with urinary leakage (p < 0.001) and both correlated with anastomotic stricture formation (p < 0.005). CONCLUSION: Excessive intraoperative blood loss (>1,000 ml) and urine leakage was found to be significantly correlated to the formation of anastomotic stricture following radical retropubic prostatectomy.     

Facilitating the technique of laparoscopic running urethrovesical anastomosis using Lapra-ty absorbable suture clips

We herein describe a simplified technique for performing laparoscopic running urethrovesical anastomosis using Lapra-ty absorbable suture clips (Ethicon, Somerville, NJ, USA) during a laparoscopic radical prostatectomy (LRP). Using two 20 cm absorbable sutures tied together and locked with Lapra-ty at their tail ends, the initiating mattress sutures are placed in the 5:30-6:30-o'clock area between the urethra and the bladder neck. The left and right running sutures are then made clockwise from the 6:30-12-o'clock position and counterclockwise from the 5:30-12-o'clock position, respectively. Both sutures are locked with proper tension by Lapra-ty at the 3, 9 and 12-o'clock positions, and then they are intracorporeally tied together just at the 12-o'clock position. In the initial 20 cases, this anastomosis took 22.5 min on average to perform. We experienced no major urine extravasation and no anastomotic stricture to date.     

腹腔镜下根治性前列腺切除术膀胱尿道单针连续吻合法

目的 介绍一种简单易行的腹腔镜下膀胱尿道连续吻合法. 方法 前列腺癌患者45例.均行根治性前列腺切除术,并采用单针连续吻合法进行膀胱尿道吻合:首先在膀胱后壁4点处做一单纯全层缝合并打结固定;然后在其附近处另起1针做顺时针膀胱尿道单纯连续缝合;从5点到8点处,每点吻合1针以确保后壁的严密;以后每2点吻合1针;为防止滑脱,每吻合3针做1针锁边吻合;最后在2点处与原预留线尾打第2个结完成吻合.吻合膀胱壁时遵循"由外到内"原则,吻合尿道壁时遵循"由内到外"原则;如出现吻合121漏,则加用单纯缝合来修补. 结果 所有吻合均顺利完成.吻合时间12～25 min,平均16 min.手术时间112～185 min,平均132 min.尿管留置7～14d,平均9 d.3例因发生暂时性漏尿需延长尿管留置时间至2周.44例(97.8%)术后1年内完全尿控,1例(2.2%)因轻微尿失禁每天使用尿垫2片;无尿道缩窄及其他短期或永久性并发症. 结论 单针连续缝合法耗时短,相对简单,易于掌握,并发症并未相应增加.     

Vesicourethral reconstruction in radical retropubic prostatectomy: an alternative technique

PURPOSE: We review an alternative method of vesicourethral reconstruction in patients undergoing radical retropubic prostatectomy for adenocarcinoma of the prostate. MATERIALS AND METHODS: A total of 91 consecutive patients were prospectively evaluated for an alternative technique for vesicourethral reconstruction which incorporates specific principles of direct suture anastomosis and the modified Vest technique. Perioperative and postoperative complications were reviewed. RESULTS: Total continence was reported in 80 of 91 patients (87.9%). Persistent moderate to severe incontinence was present in 1 patient and anastomotic stricture was identified in 7 (7.7%). Prolonged urinary extravasation was rare. CONCLUSIONS: This method of vesicourethral reconstruction appears to offer an efficient, reproducible alternative to direct suture anastomosis with acceptable complication rates.     

Initial results using a running vesicourethral anastomosis following open radical retropubic prostatectomy

PURPOSE: We assessed the results of early catheter removal following radical prostatectomy using a continuous suture vesicourethral anastomosis. MATERIALS AND METHODS: From March 2001 through December 2003, 76 patients underwent open radical prostatectomy, as performed by a single surgeon. A continuous 3-zero polyglactin suture was used for the vesicourethral anastomosis in 72 patients. Drain fluid creatinine on postoperative day 1 was used to assess anastomotic leakage. A cystogram was done before catheter removal in the initial 25 patients. Subsequently a cystogram was performed only if there was suspicion of urine leakage. RESULTS: Early catheter removal was possible in 63 of 72 patients (88%). Catheter removal occurred a mean of 3.4 days (range 1 to 6) postoperatively in this group. Ten of the 14 men who required catheter reinsertion for urinary retention had the catheter removed before postoperative day 4. In the remaining 9 patients early catheter removal was not attempted. Catheter removal occurred a mean of 10.1 days (range 7 to 14) postoperatively in this group. Overall the urethral catheter was successfully removed on or before postoperative day 6 (range 1 to 6) in 78% of patients. There was no incidence of urinoma, pelvic abscess or bladder neck contracture at a mean followup of 31 months (range 2 to 46). CONCLUSIONS: A running vesicourethral anastomosis following open radical retropubic prostatectomy allows reliable early catheter removal by postoperative days 4 to 6 in most patients with no increase in morbidity.     

逆行性膀胱颈保护技术在前列腺癌根治术中的应用和效果评价

目的:评价逆行性膀胱颈保护(BNP)技术在开放性前列腺癌根治术中的应用效果。方法:回顾性分析2011年12月~2013年6月采用逆行性BNP技术所开展的前列腺癌根治术26例患者的临床资料,观察患者手术时间、术中出血量、围手术期输血量、术后患者并发症的发生情况、术后住院时间、拔除尿管时间及随访情况等。结果:26例患者手术均采用开放性耻骨后前列腺癌根治术,手术时间130~210min,平均156min;出血量50~400ml,平均出血量210ml,无患者在围手术期输血;术后住院时间7~12天,平均8.9天;术后病理分期为T2期23例,T3a期3例;所有患者术后病理检查均未发现盆腔淋巴结阳性,无手术切缘阳性;围手术期未发生膀胱-尿道吻合口漏;拔除尿管后,患者排尿均通畅,无吻合口狭窄发生。本组26例患者均在术后7天拔除尿管,其中5例患者在术后1周内恢复尿控功能,12例患者在术后4周内恢复尿控功能,其余9例患者在术后3个月内恢复尿控功能。所有患者在3个月后均能正常排尿,无排尿困难和尿失禁表现;3个月后复查血PSA,其中23例患者均达到0.02μg/L以下水平,其余3例患者PSA下降未达到以上标准,随后进行了辅助盆腔外放射治疗。结论:同国内外相关研究结果相比较,逆行性BNP技术可以提高前列腺癌根治术后患者的尿控能力,降低手术并发症,提高患者术后生活质量,是一种安全有效的手术方法。     

新辅助内分泌治疗结合机器人辅助根治性前列腺切除术治疗高危前列腺癌的优势

目的：探讨高危前列腺癌患者行新辅助内分泌治疗（neoadjuvant hormonal therapy, NHT）后,行机器人辅助腹腔镜根治性前列腺切除术（robot-assisted laparoscopic radical prostatectomy, RALRP）较腹腔镜根治性前列腺切除术（laparoscopic radical prostatectomy, LRP） 和耻骨后根治性前列腺切除术 （ retropubic radical prostatectomy, RRP）的优势。方法：回顾性分析我院自2010年3月-2012年1月以新辅助内分泌治疗结合根治性前列腺切除术治疗的16例高危前列腺癌的临床资料。术前采取3-6个月的LHRH-a＋抗雄药物的最大程度雄激素阻断方法（maximal androgen blockage,MAB）作为NHT方案,NHT后PSA均降至0．2μg／L以下。之后,其中5例接受RALRP,5例接受LRP,6例接受RRP。三组患者治疗前基线情况（年龄、PSA水平、Gleason评分）差异无统计学意义（P〉0．05）。结果：手术均获成功。中位手术时间（operating time,OT）、失血量（esti-mated blood loss,EBL）、住院天数（hospital stay,HS）在RALRP组为225min（包括机器人到位15min）、600mI、7d,在LRP组为280min、900mi、7d,在RRP组为150min、675ml、14．5d。三组患者术后均无尿漏,术后3天拔除双侧引流管。术后病理均无切缘阳性。三组各有1例患者在术后3个月时因PSA复燃而接受辅助性内分泌治疗（P=1．00）。术后3个月时,除2例RRP组患者尚存压力性尿失禁,其余患者均恢复尿控（P=0．29）。结论：对于接受NHT的高危前列腺癌患者而言,相对于开放手术和腹腔镜根治性前列腺切除术,机器人辅助腹腔镜根治性前列腺切除术仍然是这些患者的更佳选择。