Application of the midline bilateral suturing technique in laparoscopic radical prostatectomy for managing the dorsal venous complex
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摘要: 目的 探讨腹腔镜前列腺癌根治术中使用正中双侧缝合法处理阴茎背血管复合体(dorsal vascular complex，DVC)的手术方法。方法 选取昆明医科大学第二附属医院我医疗组2020年3月—2022年3月行腹腔镜下前列腺癌根治术的81例患者，根据处理DVC的方法不同将其分为传统缝合组(38例)和正中双侧缝合组(43例)，比较2组患者的一般资料、术中相关资料及术后恢复指标有无差异。结果 2组患者的一般资料、手术时间比较差异无统计学意义(P>0.05)。正中双侧缝合组的术中出血量、术后切缘阳性率及术后1、3个月控尿恢复率均优于传统缝合组(P < 0.05)，术后6个月控尿恢复率差异无统计学意义(P>0.05)。结论 正中双侧缝合法可有效控制术中出血，显著降低前列腺尖部切缘阳性率，有利于术后患者早期控尿的恢复。
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关键词:
- 阴茎背血管复合体 /
- 腹腔镜下前列腺癌根治术 /
- 控尿功能 /
- 切缘阳性 /
- 术中出血量
Abstract: Objective To explore the surgical technique of the midline bilateral suturing for the management of the dorsal vascular complex(DVC) in laparoscopic radical prostatectomy for prostate cancer.Methods Between March 2020 and March 2022, 81 patients who underwent laparoscopic radical prostatectomy at Second Affiliated Hospital of Kunming Medical University were selected. These patients were divided into two groups according to the different techniques used to manage the DVC--the traditional suturing group(38 patients) and the midline bilateral suturing group(43 patients). The general information, intraoperative data, and postoperative recovery indicators of both groups were compared to ascertain any differences.Results There was no significant difference in the general information or surgery duration between the two groups(P>0.05). The midline bilateral suturing group showed less intraoperative blood loss, a lower rate of positive surgical margins, and higher rates of urinary continence recovery at 1 and 3 months postoperatively compared to the traditional suturing group(P < 0.05). At 6 months postoperatively, the difference in urinary continence recovery rates was not statistically significant(P>0.05).Conclusion The midline bilateral suturing technique is effective in controlling intraoperative bleeding and significantly reducing the positive margin rate at the apex of the prostate, which is beneficial for early postoperative recovery of urinary continence in patients. -
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表 1 2组患者的一般资料比较
X±S 组别 例数 年龄/岁 BMI/(kg/m2) 术前PSA/(μg/L) 前列腺体积/cm3 正中双侧缝合组 41 68.24±7.24 20.59±2.70 17.49±3.67 56.71±6.23 传统缝合组 38 68.79±7.39 21.34±2.32 17.89±3.75 56.42±6.46 t -0.331 -1.331 -0.488 0.200 P值 0.741 0.187 0.627 0.842 
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表 2 2组手术资料比较
X±S 组别 例数 手术时间/min 手术出血量/mL 正中双侧缝合组 41 199.41±11.64 140.20±17.94 传统缝合组 38 200.58±15.95 149.08±19.38 t -0.372 -2.109 P值 0.711 0.038
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表 3 2组术后指标比较
例(%) 术后指标 正中双侧缝合组(41例) 传统缝合组(38例) χ2 P值 术后1个月控尿恢复 31(75.6) 20(52.6) 4.551 0.033 术后3个月控尿恢复 39(95.1) 29(76.3) 5.820 0.016 术后6个月控尿恢复 39(95.1) 35(92.1) 0.008 0.930 术后切缘阳性 3(7.3) 9(23.7) 4.101 0.043
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