摘要
目的:探讨腹腔镜根治性前列腺切除术后尿失禁的预防与治疗措施。方法:回顾性分析35例腹腔镜前列腺癌根治术后尿失禁患者围手术期临床资料及术后随访治疗情况,观察术后尿失禁的发生及恢复情况。结果:35例前列腺癌患者手术时均行保护尿道膜部括约肌和前列腺血管神经束的相关措施,并在分离颈部时解剖性分离到尿道,保留膀胱颈部,避免膀胱颈口过大,吻合时加强后壁;术后拔除尿管后均有即刻尿失禁,术后进行辅助功能锻炼加药物治疗及心理疏导,随访12~24个月,除2例患者因年龄较大,训练配合不佳,1例有严重糖尿病,术后轻度尿失禁持续6个月后恢复外,其余32例患者术后2~4个月均恢复尿控。结论:术前充分评估患者客观情况,术中精细操作及手术的技巧和改良,术后辅助功能锻炼加药物治疗及心理疏导,可以减少腹腔镜根治性前列腺切除术后尿失禁的发生,并使患者的控尿功能尽早恢复。
Objective:To analyze the prevention and treatment of urinary incontinence after laparoscopic radical prostatectomy.Methods:The clinical data and follow-up results of 35 patients who received the laparoscopic radical prostatectomy were studied retrospectively,and the postoperative urinary incontinence and recovery were observed.Results:During the surgery,the membrane urethra sphincter and neurovascular bundle of the 35 patients were protected.At the same time,the urethra was isolated anatomically when separating the bladder neck.The bladder neck was preserved to avoid a large bladder neck incision,and the posterior wall was sutured securely in the anastomosis.After removal of ureter,urinary incontinence occurred immediately.During the follow-up period of 12 to 24months,32 cases obtained recovery of the urinary control function within 2-4months by auxiliary exercise plus drug treatment and psychological counseling,except for 2older patients with poor matched training,and 1patient with severe diabetes,who recovered 6months after the operation.Conclusions:Full preoperative assessment of patients,accurate intraoperative operation skills and auxiliary function exercise plus drug treatment and psychological counseling after operations were three key factors in reducing the occurrence of urinary incontinence after laparoscopic radical prostatectomy.
出处
《微创泌尿外科杂志》
2016年第1期13-15,共3页
Journal of Minimally Invasive Urology
关键词
腹腔镜
根治性前列腺切除
尿失禁
retroperitoneal laparoscopy
radical prostatectomy
urinary incontinence
