腹腔镜前列腺癌根治术中双针倒刺缝合法行膀胱尿道吻合术后早期尿控恢复的效果观察

目的:分析在腹腔镜前列腺癌根治术膀胱尿道吻合中采用双针倒刺缝合法对术后早期尿控率的影响。方法:回顾性分析2013年1月至2019年1月我科40例腹腔镜前列腺癌根治术资料，膀胱尿道吻合采用双针倒刺缝合组21例，单针连续缝合组19例，均由同一位有经验的主任医师完成手术，统计分析患者一般资料、手术及术后相关资料。结果:40例均无中转开放，术中输血2例（单针连续缝合组），术后尿漏2例（各1例），均保守治疗治愈。术后尿道狭窄2例（各1例），均予扩张治疗。两组年龄、体质指数（BMI）、前列腺体积、术前前列腺特异性抗原（PSA）、病理Gleason评分及术后尿管留置时间上均无统计学差异（P＞0.05），而在手术时间、手术出血量、膀胱尿道吻合时间及住院天数上，双针倒刺缝合组明显少于单针连续缝合组，有统计学差异（P<0.05）。在术后尿控率上，双针倒刺缝合组在术后1个月、3个月尿控率分别为48%、81%，明显优于单针连续缝合组的16%、47%，差异有统计学意义（P＜0.05）。而在术后6个月及12个月尿控率，双针倒刺缝合组为90%、100%，单针连续缝合组为84%、95%，差异无统计学意义（P＞0.05）。结论:采用双针倒刺缝合行膀胱尿道吻合在腹腔镜下前列腺癌根治术中安全可行，有助于术后早期尿控恢复。

The effect observation of double-needle barb cystourethral anastomosis in laparoscopic radical prostatectomy on the recovery of urinary control in early postoperative period

Objective:To analyze the rate of early urinary continence after laparoscopic radical prostatectomy in cystourethrostomy with double-needle barbed suture.Methods:The datas of 40 cases of laparoscopic radical prostatectomy in our department from January 2013 to January 2019 were retrospectively analyzed,21 cases of the double-needle barbed suture group and 19 cases of the single-needle continuous suture group for cystourethrostomy,which were completed by one experienced chief physicians,then the general datas,surgical and postoperative datas of patients were analyzed statistically.Results:None of the 40 cases underwent open surgery.2 cases received intraoperative blood transfusion(single-needle continuous suture group)and 2 cases received postoperative urine leakage(1 case each).All of which were cured by conservative treatment.Two cases(1 case each)of urethral stricture were treated with dilatation.There were no statistically significant differences in age,BMI,prostate volume,preoperative PSA,pathological Gleason score,and postoperative catheter indwelling time between the two groups(P>0.05).However,in terms of operation time,operative blood loss,duration of cystal-urethral anastomosis and length of hospital stay,the double-needle barbed suture group was significantly less than the single-needle continuous suture group,with statistically significant differences.In terms of postoperative urinary control rate,the urine control rates of the double-needle barb suture group at 1 month and 3 months after the operation were 48%and 81%,respectively,which were significantly better than those of the single-needle continuous suture group at 16%and 47%,with statistically significant differences(P<0.05).The urine control rate at 6 months and 12 months after surgery was 90%and 100%in the double-needle barbed suture group and 84%and 95%in the single-needle continuous suture group,with no statistical significance.Conclusion:The method of cystourethrostomy with double-needle suture is safe and feasible in laparoscopic radical prostatectomy,which is helpful for the early recovery of urinary continence.