单中心比较标准和改良前列腺尖部切除技巧加快膀胱尿道吻合在腹腔镜前列腺癌根治术中的应用

报告一种改良的前列腺尖部切除技巧加快膀胱尿道吻合时间在腹腔镜前列腺癌根治术（1aparoscopic radical prostatectomy,LRP））中的应用。42例患者随机分为两组,21例行标准的LRP（1组）,21例行改良的LRP（2组）,收集患者外科资料、总手术时间、膀胱输尿管吻合时间（vesico—urethral anastomosis,VUA）,尿液外渗率、留置尿管时间、吻合口狭窄的复发、早期和晚期尿控等情况并比较分析。两组之间临床病例参数无统计学意义：总手术时间、VUA时间、失血量和留置尿管时间2组较l组明显减少（P〈0．01）;尿液的外渗率,术后吻合口狭窄两组之间无统计学意义（P〉0．05）;术后3和30天,改良组控尿率明显好于标准组（P〈0．01）,而术后90天两组控尿率无差别（P〉0．05）;提示这种新的改良的前列腺尖部切除技术能够加快UVA时间、提高手术效率,同时能够早期恢复控尿。

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 > 0.05 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.