Impact of bladder neck preservation on continence in laparoscopic radical prostatectomy for localized prostate cancer
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摘要: 目的 探讨腹腔镜根治性前列腺切除术(laparoscopic radical prostatectomy，LRP)中，保留膀胱颈部对术后尿控的影响。 方法 回顾性分析上海交通大学医学院附属瑞金医院泌尿外科于2018年1月—2022年12月行LRP的局限性前列腺癌患者160例，将保留膀胱颈组与未保留膀胱颈组的术后(1、3、6个月)尿控进行比较。 结果 160例患者中72例保留膀胱颈，88例未保留膀胱颈。保留膀胱颈组和未保留膀胱颈组的手术时间、失血量、吻合口狭窄率差异均无统计学意义(P>0.05)。术后所有患者无膀胱颈切缘阳性。行筋膜内切除患者，保留膀胱颈组术后1、3个月控尿率高于未保留膀胱颈组(P＜0.05)，术后6个月，保留膀胱颈组和未保留膀胱颈组控尿率差异无统计学意义(P>0.05)。行筋膜外切除患者，术后1、3、6个月，保留膀胱颈组和未保留膀胱颈组控尿率差异无统计学意义(P>0.05)。 结论 局限性前列腺癌行筋膜内切除，保留膀胱颈利于早期尿控恢复。对于行筋膜外LRP患者，没有必要刻意保留膀胱颈。
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关键词:
- 腹腔镜根治性前列腺切除 /
- 筋膜内 /
- 膀胱颈保留 /
- 尿控
Abstract: Objective To discuss the effects of bladder neck preservation on continence after laparoscopic radical prostatectomy(LRP). Methods The continence rate between bladder neck preservation group and non-preservation group was compared by retrospectively analyzing 160 cases of LRP for localized prostate cancer. Results There were 72 cases in bladder neck preservation group, and 88 cases in non-preservation group. No statistical significance was identified in operating time(OT), estimated blood loss(EBL), or anastomotic stricture(P>0.05). No positive margin on bladder neck was noticed pathologically in each case.In intrafascial LRP, continence rate was better in bladder neck preservation group than non-preservation group after one month and three months, but roughly the same after six months. In extrafascial LRP, there was no statistical significance between bladder neck preservation group and non-preservation group regardless of time. Conclusion The early continence recovery after LRP benefits from bladder neck preservation, which makes sense only in cases of intrafascial LRP.-
Key words:
- laparoscopic radical prostatectomy /
- intrafascia /
- bladder neck preservation /
- continence
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表 1 2组基线资料比较
例，X±S 项目 保留膀胱颈组(72例) 未保留膀胱颈组(88例) P值 年龄/岁 67.2±8.2 72.1±9.9 0.115 体积/mL 37.2±6.6 41.7±7.2 0.082 PSA /(ng/mL) 11.7±0.2 13.1±0.2 0.344 Gleason评分(6分/7分) 16/56 20/68 0.547 TNM分期(cT1N0M0/cT2N0M0) 60/12 66/22 0.138 
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表 2 2组手术数据及吻合口狭窄率比较
X±S 指标 筋膜外 筋膜内 保留膀胱颈组 未保留膀胱颈组 P值 保留膀胱颈组 未保留膀胱颈组 P值 手术时间/min 77.2±5.6 85.6±11.2 0.223 89.1±15.6 92.6±21.2 0.673 失血量/mL 35.8±7.2 32.6±6.3 0.456 111.8±22.2 99.6±17.3 0.278 吻合口狭窄率/% 10.7(3/28) 8.0(4/50) 0.714 2.3(1/44) 5.3(2/38) 0.488
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表 3 2组间尿控率(P1)比较
% 项目 保留膀胱颈组 未保留膀胱颈组 P值 筋膜外(1个月) 17.9(5/28) 14.0(7/50) 0.651 筋膜外(3个月) 42.9(12/28) 30.0(15/50) 0.252 筋膜外(6个月) 71.4(20/28) 60.0(30/50) 0.313 筋膜内(1个月) 68.2(30/44) 39.5(15/38) 0.009 筋膜内(3个月) 90.9(40/44) 65.8(25/38) 0.005 筋膜内(6个月) 95.5(42/44) 92.1(35/38) 0.527
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