摘要
目的探讨保留盆底稳定结构（PPSS）的机器人辅助根治性前列腺切除术（RARP）对尿控恢复的作用。
方法回顾性分析2017年10月至2018年4月我院行RARP的86例患者的临床资料，根据手术方式分为PPSS组和非PPSS组。PPSS组55例，年龄（69.53±6.81）岁，体重指数（23.95±3.03 ）kg/m2，前列腺体积中位值为73.39（54.88，94.23） cm3，术前PSA中位值为15.20（7.12，27.52） ng/ml，临床分期T1～T2、T3、T4期分别为40、4、2例，穿刺ISUP分级1、2、3、4、5级分别为12、10、13、10、6例。非PPSS组31例，年龄（68.48±7.79）岁，体重指数（24.79±3.05） kg/m2，前列腺体积中位值为63.54 （53.00，99.36）cm3, PSA中位值为8.45（4.42，16.78） ng/ml，临床分期T1～T2、T3、T4期分别为15、7、2例，穿刺ISUP分级1、2、3、4、5级分别为7、8、4、4、6例。两组患者年龄、体重指数、术前PSA、ISUP分级、T分期差异均无统计学意义（P〉0.05）。两组手术均采用经腹腔途径，非PPSS组进入腹腔后切开腹膜，游离膀胱前间隙，切开盆内筋膜，分离两侧肛提肌，切断耻骨前列腺韧带并结扎背血管复合体。PPSS组则不切开盆内筋膜，钝性推开盆内筋膜壁层并保留盆内筋膜腱弓，不离断耻骨前列腺韧带，不缝扎背血管复合体；处理尖部时，完全采用冷刀进行游离解剖，并尽可能保留功能尿道长度，保留精阜部尿道。术后7 d拔除尿管，比较两组拔尿管后第1、7、14、30 、90天的尿控相关指标。
结果所有手术均顺利完成。两组使用尿垫量在拔除尿管后第1、7、14、30天差异均无统计学意义（P〉0.05）；拔管后第90天，PPSS组使用尿垫量≥4张的比例显著低于非PPSS组[1.89%（1/55）与20.69%（6/31），P＝0.004]。两组拔管后第30、90天ICI-Q-SF评分差异均无统计学意义[中位值：10.0（5.5，13.0）与9.0（0，15.8），6.0（0，9.5）与9.0（0，12.0），均P〉0.05]�
ObjectiveTo investigate the effect of pelvic floor stabilized structure preservation （PPSS） during robot-assisted laparoscopic radical prostatectomy （RARP） on postoperative continence recovery.
MethodsFrom October 2017 to April 2018, 86 patients with prostatic cancer who underwent traditional RARP and RARP plus PPSS were included. There were 31 patients in non-PPSS group and 55 patients in PPSS group. In non-PPSS group, patients age was （68.48±7.79） years old, BMI was （24.79±3.05） kg/m2, median prostate volume was 63.54 （53.00-99.36）cm3, clinic T-stage T1-T2, T3, T4 accounted for 49.39%, 22.58%, 6.45% and ISUP grade 1, 2, 3, 4, 5 accounted for 22.58%, 22.81%, 12.90%, 12.90%, 19.35% respectively. In PPSS group, patients age was （69.53±6.81） years old, BMI was （23.95±3.03） kg/m2, median prostate volume was 73.39 （54.88-94.23）cm3, clinic T-stage T1-T2, T3, T4 accounted for 72.73%, 7.27%, 3.64% and ISUP grade 1, 2, 3, 4, 5 accounted for 21.82%, 18.18%, 23.64%, 18.18%, 10.91% respectively. The preoperative PSA, BMI, clinical T-stage, ISUP grade, and postoperative hospital days had no significant differences（P〉0.05） between the two groups.Both groups were operated via transperitoneal approach. In the non PPSS group, endo-pelvic fascia and pubic prostate ligament was cut, and dorsal vessel complex was ligated. In PPSS group, the partial endo-pelvic fascia was bluntly pushed to the pelvic wall to preserve tendon arch, and pubic prostate ligament also was preserved without suturing and ligating dorsal vascular complex. The catheter was removed 7 d after RARP. The continence recovery were compared between the two groups, including pad number on the day of 1, 7, 14, 30, 90 and ICI-Q-SF scores on the day of 30 and 90 after catheter removal.
ResultsThere was no significant difference in pad numbers used between the two groups on the day of 1, 7, 14, 30 after catheter removal. On the 90th day, the proportions of using pad ≥4 in PPSS group were significantly lower than those in
作者
李响
何明静
鲍一歌
邱实
金坤
杨璐
刘振华
魏强
Li Xiang; He Mingjing; Bao Yige; Qiu Shi; Jing Kun; Yang Lu; Liu Zhenhua; Wei Qiang(Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu 610041, China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2018年第10期733-739,共7页
Chinese Journal of Urology
