摘要
目的:探讨保留"尿道系膜"的腹腔镜下前列腺根治性切除术（LRP）对中高危前列腺癌（PCa）患者术后即刻尿控、早期尿控恢复的安全性及有效性。方法:回顾性分析2021年7月至2021年11月同一术者所行的18例LRP患者病例资料，所有患者均保留"尿道系膜"。平均年龄为（69±7）岁，平均前列腺体积（45±16）ml，术前PSA≥10 ng/ml 13例，BMI为（24.1±2.5）kg/m2。结果:18例患者顺利完成手术，手术时间299（267，397）min；术中失血量50（50，100）ml。术后病理均为前列腺腺泡型腺癌，Gleason评分9分4例，8分2例，7分8例，6分4例；术后TNM分期为T2a～T4期；4例患者术后切缘阳性（22%）。术后平均留置尿管时间（11±5） d。4例患者出现术后并发症，Clavien-DindoⅡ级2例，其中1例尿道感染，1例伤口感染；Clavien-DindoⅢ级2例，1例拔管后尿潴留；1例吻合口瘘尿。术后3个月复查PSA未见生化复发。拔管后即刻、1周、1个月及3个月尿控恢复率分别为61%、72%、77%及83%。结论:LRP时保留"尿道系膜"及其附着对中高危PCa术后早期尿控恢复是一种可行的术式。
Abstract
Objective:To investigate the safety and efficacy of immediate and early recovery of postoperative urinary continence by retaining the urethral mesentery during laparoscopic radical prostatectomy (LRP) in patients with moderate and high-risk prostate cancer (PCa).Methods:The clinical data of 18 LRP patients who underwent the same operation from July 2021 to November 2021 were retrospectively analyzed. All patients retained the urethral mesentery. The mean age was (69±7) years, the mean prostate volume was (45±16) ml, ther were 13 cases of preoperative prostate specific antigen (PSA) ≥10 ng/ml, and body mass index (BMI) was (24.1±2.5) kg/m2.Results:18 patients were completed the operation successfully, the median operation time was 299(267, 397) minutes and the median intraoperative blood loss was 50(50, 100) ml. Postoperative pathology was all prostate adenocarcinoma, Gleason score was 9 in 4 cases, 8 in 2 cases, 7 in 8 cases, and 6 in 4 cases. Postoperative TNM stage was T2a-T4. Surgical margins were positive in 4 patients (22%). The average indwelling time of catheter was (11±5) days. Postoperative complications occurred in 4 patients. Among them 2 cases were Clavien-Dindo class Ⅱ, including 1 urinary tract infection and 1 wound infection. 2 cases were Clavien-Dindo grade Ⅲ, including 1 urinary retention after extubation and 1 anastomotic leakage. PSA re-examination 3 months after the operation showed no biochemical recurrence. The continence rate was 61%, 72%, 77% and 83% immediately, 1 week, 1 month and 3 months after extubation.Conclusion:Retaining the urethral mesentery improves early recovery of urinary continence after LRP in middle and high risk PCa patients.
基金项目
广东省自然科学基金面上项目(2019A1515010386)
万方数据