切换至 "中华医学电子期刊资源库"

中华腔镜泌尿外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (01) : 19 -24. doi: 10.3877/cma.j.issn.1674-3253.2024.01.004

临床研究

保留"尿道系膜"的腹腔镜下前列腺根治性切除术后尿控情况的研究
李俊涛, 张天佑, 叶雷, 郭强, 吴坚坚, 尧冰, 王德娟, 邱剑光()   
  1. 510655 广州,中山大学附属第六医院泌尿外科
  • 收稿日期:2022-08-09 出版日期:2024-02-01
  • 通信作者: 邱剑光
  • 基金资助:
    广东省自然科学基金面上项目(2019A1515010386)

Retention of urethral mesangium during laparoscopic radical prostatectomy for recovery of urinary control in prostate cancer

Juntao Li, Tianyou Zhang, Lei Ye, Qiang Guo, Jianjian Wu, Bing Yao, Dejuan Wang, Jianguang Qiu()   

  1. Department of Urology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China
  • Received:2022-08-09 Published:2024-02-01
  • Corresponding author: Jianguang Qiu
引用本文:

李俊涛, 张天佑, 叶雷, 郭强, 吴坚坚, 尧冰, 王德娟, 邱剑光. 保留"尿道系膜"的腹腔镜下前列腺根治性切除术后尿控情况的研究[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(01): 19-24.

Juntao Li, Tianyou Zhang, Lei Ye, Qiang Guo, Jianjian Wu, Bing Yao, Dejuan Wang, Jianguang Qiu. Retention of urethral mesangium during laparoscopic radical prostatectomy for recovery of urinary control in prostate cancer[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(01): 19-24.

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。

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.

表1 18例前列腺癌患者术前临床资料(4例术前诊断BPH,术后病理诊断PCa)
表2 18例前列腺癌患者腹腔镜前列腺根治性切除术术中及术后情况
图1 腹腔镜下前列腺根治性切除术保留"尿道系膜"等解剖结构手术图片和示意图注:a为常规技术,即尿道系膜被剥离,尿道被裸化;b为研究技术,即尿道系膜保留,尿道不裸化;c为尿道系膜示意图
[1]
中国抗癌协会泌尿男生殖系统肿瘤专业委员会前列腺癌学组, 戴波, 叶定伟, 等. 前列腺癌筛查中国专家共识(2021年版)[J].中国癌症杂志. 2021, 31(5): 6.
[2]
Abdollah F, Sood A, Sammon JD, et al. Long-term cancer control outcomes in patients with clinically high-risk prostate cancer treated with robot-assisted radical prostatectomy: results from a multi-institutional study of 1100 patients[J]. Eur Urol, 2015, 68(3): 497-505.
[3]
Wang Z, Ni Y, Chen J, et al. The efficacy and safety of radical prostatectomy and radiotherapy in high-risk prostate cancer: a systematic review and meta-analysis[J].World J Surg Oncol, 2020, 18(1):1-13.
[4]
Moris L, Cumberbatch MG, Van den Broeck T, et al. Benefits and risks of primary treatments for high-risk localized and locally advanced prostate cancer: an international multidisciplinary systematic review[J]. Eur Urol, 2020,77(5): 614-627.
[5]
Nyarangi-Dix JN, Radtke JP, Hadaschik B, et al. Impact of complete bladder neck preservation on urinary continence, quality of life and surgical margins after radical prostatectomy: a randomized, controlled, single blind trial[J]. J Urol, 2013, 189(3): 891-898.
[6]
Patel VR, Coelho RF, Palmer KJ, et al. Periurethral suspension stitch during robot-assisted laparoscopic radical prostatectomy: description of the technique and continence outcomes[J]. Eur Urol, 2009, 56(3): 472-478.
[7]
Qiu X, Li Y, Chen M, et al. Retzius-sparing robot-assisted radical prostatectomy improves early recovery of urinary continence: a randomized, controlled, single-blind trial with a 1-year follow-up[J].BJU Int, 2020, 126(5): 633-640.
[8]
Rosenberg JE, Jung JH, Lee H, et al. Posterior musculofascial reconstruction in robotic-assisted laparoscopic prostatectomy for the treatment of clinically localized prostate cancer[J].The Cochrane Database Syst Rev, 2021, 8(8): Cd013677.
[9]
Ficarra V, Novara G, Rosen RC, 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.
[10]
张旭. 前列腺根治性切除术尿控之关键外科因素解析——从解剖基础到临床应用[J]. 现代泌尿生殖肿瘤杂志, 2022, 14(6): 321-324.
[11]
Vis AN, van der Poel HG, Ruiter AE, et al. Posterior, anterior, and periurethral surgical reconstruction of urinary continence mechanisms in robot-assisted radical prostatectomy: a description and video compilation of commonly performed surgical techniques[J]. Eur Urol, 2019, 76(6): 814-822.
[12]
Ficarra V, Rossanese M, Crestani A, et al. Robot-assisted radical prostatectomy using the novel urethral fixation technique versus standard vesicourethral anastomosis[J]. Eur Urol, 2021,79(4): 530-536.
[13]
Barakat B, Othman H, Gauger U, et al. Retzius sparing radical prostatectomy versus robot-assisted radical prostatectomy: which technique is more beneficial for prostate cancer patients (MASTER Study)? A systematic review and meta-analysis[J]. Eur Urol Focus, 2022, 8(4): 1060-1071.
[14]
Pansadoro V, Brassetti A. Extrafascial robot-assisted laparoscopic radical prostatectomy in locally advanced prostate cancer[J]. Minerva Chir, 2018, 74(1): 78-87.
[15]
Shin TY, Lee YS. Robot-assisted radical prostatectomy with clipless intrafascial neurovascular bundle-sparing approach: surgical technique and one-year functional and oncologic outcomes[J]. Sci Rep, 2020, 10(1): 1-8.
[16]
Zhao Z, Zhu H, Yu H, et al. Comparison of intrafascial and non-intrafascial radical prostatectomy for low risk localized prostate cancer[J]. Sci Rep, 2017, 7(1): 1-11.
[17]
Wagaskar VG, Mittal A, Sobotka S, et al. Hood technique for robotic radical prostatectomy—preserving periurethral anatomical structures in the space of retzius and sparing the pouch of douglas, enabling early return of continence without compromising surgical margin rates[J]. Eur Urol, 2021, 80(2): 213-221.
[18]
Egan J, Marhamati S, Carvalho FLF, et al. Retzius-sparing robot-assisted radical prostatectomy leads to durable improvement in urinary function and quality of life versus standard robot-assisted radical prostatectomy without compromise on oncologic efficacy: single-surgeon series and step-by-step guide[J]. Eur Urol, 2021, 79(6): 839-857.
[19]
Pavlovich C, Rocco B, Druskin S, et al. Urinary continence recovery after radical prostatectomy - anatomical/reconstructive and nerve-sparing techniques to improve outcomes[J]. BJU Int, 2017, 120(2): 185-196.
[20]
Nunez Bragayrac LA, Hussein AA, Attwood K, et al. Feasibility and continence outcomes of extended prostatic urethral preservation during robot-assisted radical prostatectomy[J]. Prostate cancer prostatic Dis, 2020, 23(2): 286-294.
[21]
Ferreira A, Duarte Cruz C. The urethra in continence and sensation: Neural aspects of urethral function[J]. Neurourol Urodyn, 2021, 40(3): 744-752.
[22]
Walz J, Epstein JI, Ganzer R, et al. A critical analysis of the current knowledge of surgical anatomy of the prostate related to optimisation of cancer control and preservation of continence and erection in candidates for radical prostatectomy: an update[J]. Eur Urol, 2016, 70(2): 301-311.
[23]
Freire MP, Weinberg AC, Lei Y, et al. Anatomic bladder neck preservation during robotic-assisted laparoscopic radical prostatectomy: description of technique and outcomes[J]. Eur Urol, 2009, 56(6): 972-980.
[24]
Zaorsky NG, Calais J, Fanti S, et al. Salvage therapy for prostate cancer after radical prostatectomy[J]. Nat Rev Urol, 2021, 18(11): 643-668.
[25]
Panebianco V, Villeirs G, Weinreb JC, et al. Prostate magnetic resonance imaging for local recurrence reporting (PI-RR): international consensus -based Guidelines on multiparametric magnetic resonance imaging for prostate cancer recurrence after radiation therapy and radical prostatectomy[J]. Eur Urol Oncol, 2021, 4(6): 868-876.
[1] 刘涛, 樊保佑, 史仲举, 刘德荣, 王沛. 股骨距是一个容易被误解的人体结构[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 626-629.
[2] 吴晖, 佴永军, 施雪松, 魏晓为. 两种解剖入路下行直肠癌侧方淋巴结清扫的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 40-43.
[3] 胡森焱, 徐冬, 方健, 谢冬冬, 王财庆. ICG荧光显影Laennec膜入路腹腔镜解剖性肝切除的临床研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 513-516.
[4] 林巧, 周丽. RFA联合LAH术治疗原发性肝癌并门静脉癌栓的临床效果分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 521-524.
[5] 刘连新, 孟凡征. 不断提高腹腔镜解剖性肝切除的规范化[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 355-358.
[6] 祝炜安, 林华慧, 吴建杰, 黄炯煅, 吴婷婷, 赖文杰. RDM1通过CDK4促进前列腺癌细胞进展的研究[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 618-625.
[7] 王功炜, 李书豪, 魏松, 吕博然, 胡成. 溶瘤病毒M1对不同前列腺癌细胞杀伤效果的研究[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 626-632.
[8] 施一辉, 张平新, 朱勇, 杨德林. 机器人辅助前列腺根治术后切缘阳性的研究进展[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 633-637.
[9] 李伟, 宋子健, 赖衍成, 周睿, 吴涵, 邓龙昕, 陈锐. 人工智能应用于前列腺癌患者预后预测的研究现状及展望[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 541-546.
[10] 吴登爽, 李墨农, 张欣红, 侯四川, 邱志磊. 解剖性显微镜下精索静脉结扎术的临床研究[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 591-596.
[11] 胡思平, 熊性宇, 徐航, 杨璐. 衰老相关分泌表型因子在前列腺癌发生发展中的作用机制[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(05): 425-434.
[12] 杨勇军, 曾一鸣, 贺显雅, 卢强, 李远伟. ASA分级≥Ⅲ级患者局麻经会阴前列腺多模态影像融合穿刺的安全性和有效性[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(05): 441-447.
[13] 李鑫钊, 张廷涛, 朱峰, 刘金山, 刘大闯. 血纤维蛋白原、D-二聚体及碱性磷酸酶诊断前列腺癌骨转移的价值分析[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(05): 459-463.
[14] 刘中文, 刘畅, 高洋, 刘东, 林世庆, 杨建华, 赵福义. 尿液microRNA-326与腹腔镜根治性膀胱切除术治疗膀胱癌患者预后的相关性研究[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(04): 386-391.
[15] 刘颖斌, 陈炜. 胰腺全系膜切除理念存在的问题与争议[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 615-619.
阅读次数
全文


摘要