摘要
目的探讨膀胱黏膜光滑程度(BMS)与腹腔镜根治性前列腺切除术(LRP)后早期(3个月)控尿功能恢复的相关性。方法回顾性分析北京大学第三医院2016年1月至2020年3月收治的192例前列腺癌患者行LRP的临床资料。年龄(69.1±8.0)岁,穿刺前前列腺特异性抗原(PSA)12.23(7.45,20.36)ng/ml;穿刺Gleason评分<7分和≥7分者分别为69例(35.9%)和123例(64.1%);临床分期T_(1~2)期92例(47.9%)T_(3)期100例(52.1%)。所有患者于前列腺穿刺活检前完善MRI检查,术前MRI测量前列腺体积(PV)为35.4(26.3,51.1)ml;膜性尿道长度(MUL)为(13.9±3.5)mm;前列腺突入膀胱深度(IPPL)<5mm者128例(66.7%)IPPL≥5mm者64例(33.3%)。根据MRI影像将BMS分为4个分级:0级,膀胱黏膜完全光滑;1级,膀胱黏膜可见少量不平整凹凸;2级,膀胱黏膜可见深入肌层的裂隙,深度≤1/2膀胱壁厚度,或出现膀胱憩室;3级,膀胱裂隙深度>1/2膀胱壁厚度,或裂隙进展成为小块状的肌层缺失。本研究BMS为0级63例(32.8%),1级95例(49.5%),2~3级34例(17.7%)。术后自第1个月起每月对患者的控尿功能恢复情况进行随访。以全天不需要使用尿垫为控尿功能恢复,每日使用≥1个尿垫为尿失禁。应用logistic多因素回归分析影响术后早期控尿功能恢复的危险因素。采用Kaplan-Meier法绘制LRP术后患者控尿功能恢复曲线,log-rank检验比较各组间术后控尿功能恢复曲线的差异。结果所有手术均顺利完成。术后1.、3、6、12个月患者控尿率分别为40.1%(77/192)57.8%(111/192)71.9%(138/192)和90.1%(173/192)。术后早期(3个月)尿失禁的单因素分析中,PV<40ml患者的尿失禁比例低于≥40ml者[33.0%(38/115)与55.8%(43/77)]、MUL<14mm患者尿失禁比例高于MUL≥14mm者[75.7%(56/74)与21.2%(25/118)],IPPL<5mm患者的尿失禁比例低于≥5mm患者[26.6%(34/128)与73.4%(47/64)]、BMS0级患者尿失禁比例低于BMS1级、2~3级患者[23.8%(15/63)与47.4%(45/95)与61.8%(21/34)],差异均有统计学意义(P
Objective To investigate the correlation between bladder mucosal smoothness(BMS)and early urinary continence recovery following laparoscopic radical prostatectomy(LRP).Methods A retrospective analysis was conducted on the clinical data of 192 prostate cancer patients who underwent LRP at Peking University Third Hospital between January 2016 and March 2020.The patients'average age was(69.1±8.0)years old,and the median pre-biopsy PSA level was 12.23(7.45,20.36)ng/ml.There were 69 patients(35.9%)with a Gleason score<7 and 123 patients(64.1%)with a Cleason score≥7.Clinical staging showed that 92 patients(47.9%)were in stage T_(1)/T_(2),and 100 patients(52.1%)were in stage T_(3).All patients underwent MRI before prostate biopsy.The preoperative MRI measured the prostate volume(PV)as 35.4(26.3,51.1)ml,and membranous urethral length(MUL)as(13.9±3.5)mm.The intravesical prostatic protrusion length(IPPL)was<5 mm in 128 patients(66.7%)and≥5 mm in 64 patients(33.3%).All patients completed MRI examination before biopsy,BMS was defined into four grades according to MRI:grade O,the bladder mucosa is completely smooth;grade 1,a small amount of unevenness and bumps can be seen in the bladder mucosa;grade 2,fissures can be seen in the bladder mucosa,less than half of the bladder wall,or bladder diverticulum;grade 3,the bladder fissure exceeds half of the bladder wall,or fissure progresses to a small loss of muscularis.In this study,there were 63 patients(32.8%)with grade 0,95 patients(49.5%)with grade 1,and 34 patients(17.7%)with grade 2-3.Postoperatively,patients were followed up monthly from the first month onwards to assess urinary continence recovery,defined as not requiring pads throughout the day.Logistic multivariate regression analysis was used to identify risk factors affecting early postoperative urinary continence recovery,and log-rank test was used to compare postoperative urinary continence recovery curves among different groups.Results All surgeries were successfully completed.The complete urinary continence ra
作者
张帆
颜野
虞乐
褚红玲
郝一昌
黄毅
马潞林
张树栋
Zhang Fan;Yan Ye;Yu Le;Chu Hongling;Hao Yichang;Huang Yi;Ma Lulin;Zhang Shudong(Department of Urology,Peking University Third Hospital,Beijing 100191,China;Research Center of Clinical Epidemiology,Peking University Third Hospital,Beijing 100191,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2024年第11期825-830,共6页
Chinese Journal of Urology
