Effect of intact bladder annular muscle and proximal urethra in RARP on immediate postoperative urinary control
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摘要: 目的 研究在机器人辅助腹腔镜下前列腺癌根治术(robot-assisted laparoscopic radical prostatectomy，RARP)中完整保留膀胱环形肌和近端尿道对患者术后即刻尿控的影响，进而指导临床工作。方法 选取2021年4月—2022年8月就诊于蚌埠医学院附属合肥市第二人民医院的31例前列腺癌患者，根据术中是否完整保留膀胱环形肌和近端尿道，随机分为完整保留膀胱环形肌和近端尿道组15例(试验组)与不保留膀胱环形肌和近端尿道组16例(对照组)。比较2组术前资料、术中出血量及手术时间、术后尿控及并发症等指标。结果 试验组手术时间、术中出血量、切缘阳性率、术后病理分期、术后并发症、导尿管留置时间、盆腔引流管留置时间及住院时间与对照组比较差异无统计学意义(P>0.05)。试验组和对照组患者的术后即刻尿控(拔除导尿管后24 h内使用尿垫数)、1个月及3个月国际尿失禁咨询委员会尿失禁问卷简表(ICIQ-SF)评分差异有统计学意义(P < 0.05)；2组即刻尿控率、术后1个月及3个月尿控率分别为73.33%、80.00%、93.33%和31.25%、37.50%、62.50%，其中即刻尿控率和术后1个月尿控率差异有统计学意义(P < 0.05)。结论 对于中低危前列腺癌(定义为PSA < 20 ng/mL、临床分期不超过T2期、术前穿刺Gleason评分 < 7分)并且前列腺体积不超过80 mL的患者，在RARP中通过完整保留膀胱环形肌和近端尿道可提高患者术后即刻及1个月的尿控率。Abstract: Objective To study the effect of complete preservation of bladder annular muscle and proximal urethra in robot-assisted laparoscopic radical prostatectomy(RARP) on immediate postoperative urinary control, and then to guide clinical work.Methods From April 2021 to August 2022, 31 patients with prostate cancer treated in Hefei No. 2 People's Hospital were randomly divided into the experimental group(15 cases) and the control group(16 cases), according to whether the bladder annular muscle and proximal urethra were completely preserved during the operation. The preoperative data, intraoperative bleeding and operation time, postoperative urinary control and complications were compared between the two groups.Results There was no significant difference in operation time, intraoperative blood loss, positive rate of margin, postoperative pathological stage, postoperative complications, indwelling time of catheter, indwelling time of pelvic drainage tube or hospitalization time between the experimental group and the control group(P>0.05). There were significant differences in immediate urinary control(the number of urine pads used within 24 hours after catheter removal) and ICIQ-SF scores 1 month and 3 months after operation between the experimental group and the control group(P < 0.05). The rates of immediate urinary control, one month and three months of the experimental group and the control group after operation were 73.33%, 80.00%, 93.33% vs 31.25%, 37.50% and 62.50%, respectively. There were significant differences in rates of immediate urinary control and one month after operation(P < 0.05).Conclusion For patients with moderate and low risk prostate cancer(defined as PSA not exceeding 20 ng/mL, clinical stage not exceeding T2, preoperative puncture Gleason score not exceeding 7) and prostate volume not exceeding 80 mL, the urinary control rate of patients immediately and one month after operation can be improved by completely preserving bladder annular muscle and proximal urethra in RARP.
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Key words:
- robot /
- radical prostatectomy /
- annular muscle of bladder /
- proximal urethra /
- immediate urinary control
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表 1 2组患者术前相关资料比较
例(%)，X±S，M(P25，P75) 指标 试验组(15例) 对照组(16例) t/z P值 年龄/岁 73.20±4.21 72.69±3.67 -0.362 0.720 BMI/(kg/m2) 23.99±3.65 23.19±2.53 -0.713 0.481 前列腺体积/mL 46.14±10.33 45.69±8.82 -0.130 0.897 PSA/(ng/mL) 13.88±4.74 13.15±4.03 -0.466 0.645 Gleason评分 6.0(6.0，7.0) 7.0(6.0，7.0) -0.208 0.835 临床分期 - 0.716 T1 5(33.33) 7(43.75) T2 10(66.67) 9(56.25) 
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表 2 2组患者术中相关情况比较
X±S 指标 试验组(15例) 对照组(16例) t/z P值 手术时间/min 160.40±34.98 158.63±22.58 -0.119 0.906 出血量/mL 144.00±59.86 141.88±47.92 -0.080 0.936
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表 3 2组患者术后相关资料比较
例(%)，X±S，M(P25，P75) 指标 试验组(15例) 对照组(16例) t/z P值 病理分期 - 1.000 T2 15(100.00) 15(93.75) T3 0(0) 1(6.25) 切缘阳性情况 0(0) 1(6.25) - 1.000 术后并发症 尿液外渗 1(6.67) 1(6.25) - 1.000 感染 0(0) 1(6.25) - 1.000 导尿管留置时间/d 12.80±1.61 13.00±1.59 0.347 0.731 盆腔引流管留置时间/d 9.68±1.78 10.87±1.52 -0.283 0.777 住院时间/d 18.47±2.53 18.75±2.017 -0.419 0.676 即刻尿控/(块/d) 1.0(1.0，2.0) 2.0(1.0，3.0) -2.175 0.018 术后1个月ICIQ-SF评分 5.40±3.64 11.13±6.53 -2.128 0.008 术后3个月ICIQ-SF评分 3.00(0.00，5.00) 5.50(3.25，15.50) -2.360 0.016
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表 4 2组患者术后尿控率比较
例(%) 组别 即刻尿控 术后1个月 术后3个月 试验组(15例) 11(73.33) 12(80.00) 14(93.33) 对照组(16例) 5(31.25) 6(37.50) 10(62.50) P值 0.032 0.029 0.083
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