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。

Comparison of the efficiency of two kinds of urethrovesical anastomosis in laparoscopic radical prostatectomy

Objective:To evaluate the efficiency of a novel method of urethrovesical anatomosis(UVA)by comparing the operative and perioperative outcomes during laparoscopic radical prostatectomy(LRP).Method:From January 2007to April 2011,95patients with 1ocal prostate cancer(LPC)underwent laparoscopic radical prostatectomy through the placement of two separate needles or a single needle for running urethrovesical anastomosis.They were divided into two groups according to the method of UVA:group A,two separate needles with the ends of the suture knotted together(n=52)and group B,one needle with the end of the suture placed outside(n=43).All patients were judged in the time of operation,UVA,anastomotic leak,stricture urethrotomy,the time of the Foley catheter and the positive margins.Result:Compared with group A,It is possible to shorten both suturing time and operative time by the novel method(group A:179.9min,B:142.8min,P<0.05;group A:22.0min,B:12.9 min,P<0.05),and to obtain a hermetic anastomosis without leakage(group A:15.4%,group B:2.3%,P< 0.05).But there was no significant difference in the incidence of stricture urethrotomy,the time of the Foley catheter and the positive surgical-margin rates.Conclusion:The method of UVA with a single needle in which the end of the suture is placed outside shortens the time of UVA and total operative time,and reduces the incidence of anastomotic leak.