改良膀胱尿道吻合法在机器人辅助腹腔镜前列腺癌根治术中的应用（附89例报告）

张雪培; 范雅峰; 杨锦建; 魏金星; 王声政; 顾朝辉; 朱照伟; 董彪; 陶金

doi:10.13201/j.issn.1001-1420.2017.06.010

改良膀胱尿道吻合法在机器人辅助腹腔镜前列腺癌根治术中的应用（附89例报告）

- 郑州大学第一附属医院泌尿外科(郑州, 450052)

详细信息

通讯作者: 张雪培,E-mail:zhangxuepei@263.net

中图分类号: R737.25

收稿日期: 2016-12-27

Clinical application ofmodified urethrovesical anastomosis in robot-assisted radical prostatectomy（Report of 89cases）

- Department of Urology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China

More Information

Corresponding author: ZHANG Xuepei, E-mail: zhangxuepei@263.net

Received Date: 27 December 2016

摘要

摘要: 目的:探讨改良膀胱尿道吻合法在机器人辅助腹腔镜前列腺癌根治术(RARP)中的应用价值。方法:2014年9月~2016年9月于我院行RARP的89例患者,均采用双针倒刺自膀胱颈5点和7点连续缝合的改良膀胱尿道吻合法,回顾性分析其临床资料,患者年龄44~81岁,平均68岁;术前PSA 0.03~100ng/ml,平均9.8ng/ml;术前病理诊断腺癌88例,间质肉瘤1例;Gleason评分4~9分,平均7.4分。结果:89例手术均顺利完成,无中转开放。手术时间54~147min,平均89min;术中出血20~600ml,平均178ml;术后下床活动时间1~3d,平均1.5d;住院时间5~29d,平均9d。术后出现漏尿3例、感染1例、肠梗阻2例、尿道狭窄2例,均经保守治疗好转;另有1例切口疝经疝修补好转。术后随访1~23个月,平均9.8个月;术后3、6、12个月完全尿控率分别为86.6%(58/67)、92.7%(51/55)和96.9%(31/32)。7例患者出现生化复发,1例患者出现多发转移,1例患者死亡。结论:应用改良膀胱尿道吻合法行机器人辅助腹腔镜前列腺癌根治术安全可行,可降低术后漏尿发生率,有效改善术后尿控,值得进一步推广。
- 前列腺癌 /
- 机器人辅助腹腔镜 /
- 前列腺根治术 /
- 改良膀胱尿道吻合法
Abstract: Objective:To explore the value of modified urethrovesical anastomosis in robot-assisted radical prostatectomy (RARP). Method:From Sep.2014 to Sep.2016, 89 patients with prostate cancer underwent RARP.The mean age was 68 (range, 44-81) years old.The mean PSA before surgery was 9.8 (range, 0.03-100) ng/ml.Pathological diagnosis before surgery were adenocarcinoma in 88 cases, stromal sarcoma in 1case.The mean Gleason score was 7.4 (range, 4-9). Result:All cases were successfully completed without conversion to open operation.The mean operation time was 89 (range, 54-147) min, and mean blood loss was 178 (range, 20-600) ml.The mean postoperative activity time was 1.5 (range, 1-3) days, and mean hospital stay after surgery was9 (range, 5-29) days.Postoperative complications occurred in 9cases (10.1%). They were all cured by conservative treatment, except that one case was cured by hernia repair.During the mean follow-up period of 9.8 (range, 1-23) months, the pad-free continence rate was 86.6% (58/67) , 92.7% (51/55) and 96.9% (31/32) respectively at 3, 6and 12 months after operation.Only seven patients had biochemical recurrence, one patient experienced multiple metastases and one patient died.Conclusion:RARP with modified urethrovesical anastomosis can reduce the incidence of urinary leakage, effectively improve urinary incontinence, so it is safe and feasible and worthy of further application.
- prostate cancer /
- robot assisted laparoscopic /
- radical prostatectomy /
- modified urethrovesical anastomosis

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参考文献(18)

[1]	Center M M, Jemal A, Lortet-Tieulent J, et al.International variation in prostate cancer incidence and mortality rates[J].Eur Urol, 2012, 61 (6):1079-1092.
[2]	Dasgupta P.Improving the evidence for robot-assisted radical prostatectomy[J].Eur Urol, 2015, 67 (4):671-672.
[3]	Heidenreich A, Bastian P J, Bellmunt J, et al.EAU guidelines on prostate cancer.Part 1:screening, diagnosis, and local treatment with curative intent-update 2013[J].Eur Urol, 2014, 65 (1):124-137.
[4]	Petrut B, Coman I, Nechita F V, et al.A new device for performing the bladder Urethral anastomosis during the laparoscopic radical prostatectomy[J].Curr Urol, 2009, 198 (3):94-99.
[5]	Tyrizis S I, Katafigiotis I, Constantinides C A.All you need to know about urethrovesical anastomotic urinary leakage following radical prostatectomy[J].J Urol, 2012, 188 (2):369-376.
[6]	张旭, 居正华, 王超, 等.腹腔镜下根治性前列腺切除术膀胱尿道单针连续吻合法[J].中华外科杂志.2009, 30 (7):476-479.
[7]	Raza S J, Field E, Jay C, et al.Surgical competency for urethrovesical anastomosis during robot-assisted radical prostatectomy:development and validation of the robotic anastomosis competency evaluation[J].Urology, 2015, 85 (1):27-32.
[8]	Williams S B, Alemozaffar M, Lei Y, et al.Randomized controlled trial of barbed polyglyconate versus polyglactin suture for robot-assisted laparoscopic prostatectomy anastomosis:technique and outcomes[J].Eur Urol, 2010, 58 (6):875-881.
[9]	Van Velthoven R F, Ahlering T E, Peltier A, et al.Technique for laparoscopic running urethrovesical anastomosis:the single knot method[J].Urology, 2003, 61 (4):699-702.
[10]	Chauhan S, Coelho R, Sivaraman A, et al.Peri-operative outcomes and early complication rates after 4000robot assisted radical proststectomy[J].J Urol, 2011, 185 (4suppl 1):e375-e376.
[11]	Ball A J, Bordeau K P, Davis J W, et al.Modified running urethrovesical anastomosis after robotic assisted laparoscopic radical prostatectomy:use of solitary Lapra-Ty to secure posterior approximation[J].Urology, 2005, 66:16-18.
[12]	孙立安, 王国民, 徐志兵, 等.机器人腹腔镜根治性前列腺癌切除术130例[J].中华腔镜外科杂志 (电子版), 2013, 6 (5):357-361.
[13]	Cheng W M, Lin T P, Lin C C, et al.Standardized report for early complications of radical prostatectomy[J].Journal of the Chinese Medical Association, 2014, 77:234-241.
[14]	Rebuck D A, Haywood S, McDermott K, et al.What is the long-term relevance of clinically detected postoperative anastomotic urine leakage after robotic-assisted laparoscopic prostatectomy[J].BJU Int, 2011, 108 (5):733-738.
[15]	De Carlo F, Celestino F, Verri C, et al.Retropubic, laparoscopic, and robot-assisted radical prostatectomy:surgical, oncological, and functional outcomes:a systematic review[J].Urol Int, 2014, 93 (4):373-383.
[16]	Porpiglia F, Morra I, Lucci Chiarissi M, et al.Randomised controlled trial comparing laparoscopic and robotassisted radical prostatectomy[J].Eur Urol, 2013, 63 (4):606-614.
[17]	Ko Y H, Coelho R F, Chauhan C, et al.Factors affecting return of continence 3months after robot assisted radical prostatectomy:analysis from a large, prospective data by a single surgeon[J].J Urol, 2012, 187 (1):190-195.
[18]	Ficarra V, Novara G, Rosen R C, et al.Systematic review and meta-analysis of studies reporting urinary continence recovery after robot assisted radical prostatectomy[J].Eur Urol, 2012, 62 (3):405-417.