腹腔镜筋膜内前列腺癌根治性切除术对尿控恢复的影响及相关因素分析

目的:通过总结我院腹腔镜筋膜内前列腺癌根治性切除术的方法及患者术后尿控恢复的随访记录,对影响尿控恢复的相关因素进行分析。方法:2009年9月至2012年11月共为128例患者行腹腔镜筋膜内前列腺癌根治性切除术,患者43~78岁,平均(57.0±11.4)岁,术前血PSA 4.1~18.8 ng/ml,平均(9.9±6.1)ng/ml;临床分期T185例、T243例;活检组织Gleason评分:5分13例、6分38例、7分77例,术中不打开盆底筋膜,自膀胱颈口1点及11点位置纵行切开前列腺筋膜,紧贴前列腺包膜分离前列腺前面、两侧、尖部,最大限度保留盆底神经及肌肉组织,术后随访患者尿控变化12个月。结果:128例手术均顺利完成,无中转筋膜外前列腺癌根治性切除术,手术时间45~118 min,平均(84.0±24.6)min;术中出血量15~220 ml,平均(140.0±52.1)ml;无输血,留置尿管7~15 d,平均(11.0±3.8)d。术后随访12个月,完全尿控96例(75.0%),轻微尿失禁28例(21.9%),中度尿失禁4例(3.1%),无重度及完全尿失禁病例。结论:腹腔镜筋膜内前列腺癌根治性切除术最大限度地保留了盆底肌肉、神经组织,使术后尿控得到更好的恢复,值得推广应用。

The analysis of related factors affecting the micturition control recovery after intrafascial laparoscopic radical prostatectomy for prostatic cancer

Objective： To summarize the method of intrafascial laparoscopic radical prostatectomy for prostatic cancer and follow-up data of postoperative micturition control recovery,and analyze the related factors affecting the micturition control recovery. Methods： The intrafascial laparoscopic radical prostatectomy was performed in 128 prostatic cancer patients from Sep. 2009 to Nov. 2012. The patients were 43-78（ 57. 0 ± 11. 4） years old. Preoperative prostate specific antigen（ PSA） leve1 was 4. 1-18. 8（ 9. 9 ± 6. 1） ng /ml.85 patients were in T1 clinical stage,43 patients in T2 clinical stage. The Gleason score of biopsy tissue were 5（ n = 13）,6（ n = 38）and 7（ n = 77）. The technique was to keep the endopelvic fascia intact. The prostatic fascia was longitudinally incised at 1 and 11o＇clock points of bladder neck. And the dissection plane was direct on the prostatic capsule. The anterior,bilateral and apex of prostate were separated through this plane,the pelvic nerves and muscles were reserved as much as possible. The changes of micturition control were followed up for 12 months. Results： All the 128 surgeries were successful without conversion to extrafascial laparoscopic radical prostatectomy. The operative time was 45-118（ 84. 0 ± 24. 6） min. Intraoperative blood loss was 15-220（ 140. 0 ± 52. 1） ml. No transfusion occurred. Catheterization time was 7-15（ 11. 0 ± 3. 8） d. The patients were followed up for 12 months. 75. 0% of patients（ n =96） were continent,21. 9% of patients（ n = 28） had minimal incontinence,3. 1% of patients（ n = 4） had middle incontinence. No patients had serious and complete incontinence. Conclusions： Patients can get better continence recovery after intrafascial laparoscopic radical prostatectomy,because patients can preserve the important nerve and muscle in pelvic cavity as much as possible. This procedure should be popularized.