腹腔镜根治性前列腺切除术后影响早期尿控恢复的相关因素分析

doi:10.19558/j.cnki.10-1020/r.2019.03.009

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (712 KB) RICH HTML
输出: BibTeX | EndNote (RIS)

摘要目的探讨腹腔镜根治性前列腺切除术(LRP)术后影响早期尿控恢复的相关因素。方法选择2016年2月–2018年6月于荆州市第三人民医院和武汉大学中南医院行腹腔镜根治性前列腺切除术的患者共300例,其中术后1个月内恢复尿控的患者共108例（恢复组）,未恢复尿控的患者共192例（未恢复组）,比较两组患者的平均年龄、BMI、手术时间、术中失血量,记录患者术前和术后1个月的尿动力学参数,包括最大尿流速（Q_max）,Q_max时的逼尿肌压力、膀胱顺应性、排尿量、最大膀胱测量容量（CBC）、剩余尿量（PVR）、功能性尿道长度（FPL）和膀胱颈水平分级。结果术后1个月恢复尿控的患者共108例,占36.0%,两组患者术前的尿动力学指标对比,包括Q_max、膀胱顺应性、Q_max时的逼尿肌压力、排尿量、CBC、PVR对比均差异无统计学意义（P>0.05）,术后两组患者的Q_max、膀胱顺应性、Q_max时的逼尿肌压力,排尿量,PVR对比均差异无统计学意义（P>0.05）,但术后恢复组的FPL长度显著高于未恢复组(P<0.05),且膀胱颈水平≥1级的患者比例显著高于未恢复组,差异有统计学意义(P<0.05)。Logistic回归分析显示,保留神经血管束率、后方筋膜重建率、FPL和膀胱颈水平（≥1级）是影响患者术后1个月内尿控恢复的重要因素（P<0.05）。结论患者的FPL、术后膀胱颈水平、神经血管束保留和后方筋膜重建是影响LRP术后早期尿控恢复的重要影响因素。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	林晨
	刘湘鄂
	乔亮
	严松柏
	吴霞

关键词 ：前列腺癌, 根治术, 腹腔镜, 尿失禁, 尿道长度

Abstract：Objective: To investigate the factors affecting the recovery of early urinary control after laparoscopic radical prostatectomy (LRP).Methods: A total of 300 cases of LRP were selected from February 2016 to June 2018 in the Third People's Hospital of Jingzhou and Zhongnan Hospital of Wuhan University: 108 cases (recovery group) recovered from urinary control within 1 month after operation, and 192 cases (unrecovered group) were not recovered. The average age, body mass index (BMI), operation time, and intraoperative blood loss were compared between the two groups. The urodynamic parameters of the patients before and 1 month after surgery were recorded, including the maximum flow rate of urine (Q_max), detrusor pressure at Q_max, bladder compliance, urine output, bladder pressure volume (CBC), residual post-urinary (PVR) volume and functional urethral length (FPL) and bladder neck level. Results: A total of 108 patients recovered at 1st month postoperatively, accounting for 36.0%. The preoperative urodynamic parameters between the two groups were compared, including Q_max, bladder compliance, detrusor pressure at Q_max, urine output, CBC and PVR, showing no significant difference (P>0.05). There was no significant difference in Q_max, bladder compliance, detrusor pressure at Q_max, urine output, and PVR volume between the two groups after operation (P>0.05), but the FPL in the recovery group was significantly longer than that in the unrecovered group (P<0.05), and the proportion of patients with bladder neck level ≥1 was significantly higher in the recovery group than that in the unrecovered group (P<0.05). Logistic regression analysis showed that neurovascular bundle retention rate, posterior fascia reconstruction rate, FPL and bladder neck level (≥1) were important factors affecting urinary control within 1 month after surgery (P<0.05). Conclusion: The FPL, postoperative bladder neck level, neurovascular bundle retention, and posterior fascia reconstruction are important factors influencing the early recovery of urinary control after LRP.

Key words： prostate cancer radical surgery laparoscopy urinary incontinence urethra length

收稿日期: 2018-12-20

ZTFLH:

R737.25

基金资助:湖北省自然科学基金（2016CKB715）

通讯作者: 吴霞,63710258@qq.com

引用本文:

林晨, 刘湘鄂, 乔亮, 严松柏, 吴霞. 腹腔镜根治性前列腺切除术后影响早期尿控恢复的相关因素分析[J]. 微创泌尿外科杂志, 2019, 8(3): 184-188.
LIN Chen, LIU Xiange, QIAO Liang, YAN Songbai, WU Xia. Analysis of related factors affecting early urinary control recovery after laparoscopic radical prostatectomy. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2019, 8(3): 184-188.

链接本文:

http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1507.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2019/V8/I3/184

[1] HRUZA M, BERMEJO JL, FLINSPACH B, et al.Long-term oncological outcomes after laparoscopic radical prostatectomy. BJU Int, 2013,111(2):271-280.
[2] LOMBRAA M, IZQUIERDO L, GÓMEZ A, et al. Impact of a nurse-runclinic on prevalence of urinary incontinence and everyday life in men undergoing radical prostatectomy. J Wound Ostomy Continence Nurs, 2013,40(3):309-312.
[3] WALLERSTEDT A, CARLSSON S, STEINECK G, et al.Patient and tumour-related factors for prediction of urinary incontinence after radical prostatectomy. Scand J Urol, 2013,47(4):272-281.
[4] HOYLAND K, VASDEV N, ABROF A, et al.Post-radical prostatectomy incontinence: etiology and prevention. Rev Urol, 2014,16(4):181-188.
[5] 韦艳梅. 膀胱内前列腺突入预测腹腔镜前列腺癌根治术后早期尿控恢复的临床价值探讨.现代医学,2016,44(3):357-360.
[6] 王江平,王勤章.2014年前列腺癌指南修订要点及意义.现代泌尿外科杂志,2015,20(12):844-847,862.
[7] 许宁,蔡海,魏勇,等.最长尿道保存技术对腹腔镜前列腺癌根治术后尿控恢复的影响.中国微创外科杂志,2015,15(8):701-704.
[8] 艾青,李宏召,马鑫,等.机器人辅助腹腔镜前列腺根治性切除术中尿控和性功能保留的关键手术技巧.微创泌尿外科杂志,2017,6(1):59-61.
[9] SUARDI N, MOSCHINI M, GALLINA A, et al.Nerve-sparing approach during radical prostatectomy is strongly associated with the rate of postoperative urinary continence recovery. BJU Int, 2013,111(5):717-722.
[10] HUANG HC, JIANG YH, LIN VC, et al.Possible predictor of early recovery on urinary continence after laparoscopic radical prostatectomy-Bladder neck level and urodynamic parameters. J Formos Med Assoc, 2019,118(1Pt2):237-243.
[11] 李恭会,朱世斌,成晟,等.腹膜外腔镜下根治性前列腺切除术中保留膀胱颈对术后早期控尿功能恢复的影响.中华泌尿外科杂志,2013,34(5):361-365.
[12] MIZUTANI Y, UEHARA H, FUJISUE Y, et al.Urinary continence following laparoscopic radical prostatectomy: Association with postoperative membranous urethral length measured using real-time intraoperative transrectal ultrasonography. Oncol Lett, 2012,3(1):181-184.
[13] HAGA N, OGAWA S, YABE M, et al.Factors contributing to early recovery of urinary continence analyzed by pre- and postoperative pelvic anatomical features at robot-assisted laparoscopic radical prostatectomy. J Endourol, 2015,29(6):683-690.
[14] 蔡海,杨鹏,许宁,等.腹腔镜根治性前列腺切除术后尿控恢复影响因素分析.临床泌尿外科杂志,2016,31(10):903-906.
[15] ROCCO B, COZZI G, SPINELLI MG, et al.Posterior musculofascial reconstruction after radical prostatectomy: a systematic review of the literature. Eur Urol, 2012,62(5):779-790.
[16] ZACHOVAJEVIENE B, SIUPSINSKAS L, ZACHOVAJEVAS P, et al.Dynamics of pelvic floor muscle functional parameters and their correlations with urinary incontinence in men after radical prostatectomy. Neurourol Urodyn, 2017,36(1):126-131.