腹腔镜Sandwich法尿道及周围组织重建改善高风险组前列腺癌根治术后早期尿控的研究

目的 探讨腹腔镜Sandwich法尿道及周围组织重建技术对高风险组前列腺癌根治术后早期尿控的疗效。方法 纳入2011年1月至2015年9月于本院治疗的高风险前列腺癌患者71例,采用腹腔镜Sandwich法尿道及周围组织重建技术47例,采用单纯尿道吻合技术24例,对比两组患者年龄、体质量指数、前列腺体积、术前前列腺特异性抗原(prostate specific antigen,PSA)、临床分期、手术时间、术后引流管拔除时间、术后尿管拔除时间、病理分期、Gleason评分、术后切缘阳性率、淋巴结阳性率及拔除尿管后第2、4、12、24、52周尿控恢复情况。结果 两组患者间年龄、体质量指数、前列腺体积、术前PSA、临床分期、病理分期、Gleason评分、术后切缘阳性率、淋巴结阳性率、术后引流管拔除时间的差异均无统计学意义(P >0.05);Sandwich法尿道及周围组织重建组手术时间长于对照组(P=0.024)、术后尿管拔除时间显著早于对照组(P <0.001),拔除尿管第12周尿控恢复显著优于对照组(P=0.023)。结论 腹腔镜Sandwich法尿道及周围组织重建技术安全可行,显著改善高风险组前列腺癌根治术后早期尿控。

"Sandwich" reconstruction of the urethrovesical anastomosis contributes to early continence in laparoscopic radical prostatectomy for high-risk prostate cancer

Objective To evaluate the effect of the "Sandwich" reconstruction of the urethrovesical anastomosis contributes to early continence in laparoscopic radical prostatectomy for high-risk prostate cancer. Methods From January 2011 through September 2015, 71 high-risk prostate cancer patients were involved in the study, of whom 47 patients underwent laparoscopic radical prostatectomy with the "Sandwich" reconstruction of the urethrovesical anastomosis and 24 patients underwent laparoscopic radical prostatectomy with standard urethrovesical anastomosis. Outcome data including patient age, body mass index, prostate volume, preoperative prostate specific antigen, Gleason score, clinical stage, operation time, removal of drainage tube's time, removal of catheter time, pathologic stage, lymph node dissection rate, positive surgical margins rate and urinary continence were assessed at 2, 4, 12, 24 and 52 weeks after catheter removal.Results No significant differences were found between the two groups in terms of patient age, body mass index, prostate volume, preoperative prostate specific antigen, Gleason score, clinical stage, removal of drainage tube time, lymph node dissection rate and positive surgical margins rate; The operation time of "Sandwich" reconstruction of the urethrovesical anastomosis was longer than the time of standard urethrovesical anastomosis (P=0.024). A significant difference in removal of catheter time was recorded between the two groups (14.35±1.83) d in "Sandwich" reconstruction of the urethrovesical anastomosis vs (6.53±0.85)d in standard urethrovesical anastomosis (P <0.001)]; A significant difference of urinary continence was also recorded between the groups (50% in standard urethrovesical anastomosis vs 76.6% in "Sandwich" reconstruction of the urethrovesical anastomosis, P=0.023) after 12 weeks. Conclusion "Sandwich" reconstruction technique in the procedure of urethrovesical anastomosis during laparoscopic radical prostatectomy is safe and feasible, which can improve early recovery of continence for high-risk prostate cancer significantly.