摘要
目的研究机器人辅助不同膀胱入路前列腺癌根治术的临床疗效,分析术后尿控功能的影响因素。方法选取2017年3月至2019年5月本院收治的103例前列腺癌患者为研究对象,根据不同膀胱入路分为膀胱前入路组(A组,53例)与膀胱后入路组(B组,50例)。比较两组围手术期指标、术后1、3个月生活质量(QOL)评分、Gleason评分、前列腺特异抗原(PSA)值、尿控有效率,分析术后尿控功能的影响因素。结果A组手术时间、术中出血量、住院时间、尿管留置时间显著少于B组(P<0.05);两组术后3个月尿控有效率比较,差异无统计学意义(67.9%vs.58.0%,P>0.05);两组术后1、3个月QOL评分、Gleason评分较术前显著升高,PSA值显著降低(P<0.05),A组术后1、3个月QOL评分、Gleason评分显著高于B组,术后1个月PSA值显著低于B组(P<0.05);体重指数(BMI)<28 kg/m^(2)、后方颈膜重建及保留膀胱颈、最长尿道及神经血管束患者的尿控率明显高于BMI≥28 kg/m^(2)、未进行后方颈膜重建、未保留膀胱颈、最长尿道及神经血管束患者,且差异有统计学意义(P<0.05);BMI≥28 kg/m^(2)、神经血管束损伤是影响术后尿控功能的危险因素(P<0.05)。结论机器人辅助经膀胱前入路前列腺癌根治术出血少,术后尿控功能恢复较好,有助于改善患者生活质量,肥胖和神经血管束损伤对术后尿控功能有不利影响。
Objective To investigate the clinical efficacy of robotic-assisted radical resection of prostalic cancer through different approaches,and analyze factors affecting urinary continence function.Methods From March 2017 to May 2019,103 patients with prostatic cancer underwent robotic-assisted radical resection in our hospital were enrolled,and divided into two groups according to different surgical approaches.Group A(53 cases)received surgery through anterior bladder approach,while group B(50 cases)received surgery through posterior bladder approach.The perioperative indicators,quality of life score,Gleason score,prostate specific antigen(PSA),and urinary continence efficiency of two groups were compared,and the influencing factors of urinary continence function after operation were analyzed.Results The operation time,intraoperative blood loss,hospital stay length,and catheter indwelling time in group A were significantly lower than those in group B(P<0.05).The urinary continence efficiency at postoperative 3 months showed no significant difference between groups(67.9%vs.58.0%,P>0.05).At postoperative 1 month and 3 months,the quality of life score and Gleason score were increased in both groups(P<0.05),and were higher in group A than in group B(P<0.05),meanwhile,the PSA was decreased in both groups(P<0.05),and was lower in group A than in group B(P<0.05).The urinary control rate of patients with body mass index<28 kg/m^(2),posterior cervical membrane weight and bladder neck,longest urethra and neurovascular bundle were significantly higher than those with body mass index≥28 kg/m^(2),without posterior cervical membrane weight,without retaining bladder neck,longest urethra and neurovascular bundle(P<0.05).Body mass index ≥28 kg/m^(2)and neurovascular bundle injury were risk factors for postoperative urinary continence function(P<0.05).Conclusions Robotic-assisted radical resection of prostatic cancer via anterior bladder approach has less bleeding and better postoperative urinary continence function,which can effectively improve the quality of life,moreover,obesity and neurovascular bundle injury exert adverse effects on postoperative urinary continence function.
作者
张志明
桑楠
邱建新
张波
薛炜
Zhang Zhiming;Sang Nan;Qiu Jianxin;Zhang Bo;Xue Wei(Department of Urology,the Second Affiliated Hospital of PLA Air Force Military Medical University,Xi'an 710038,China;Department of Oncology,the Second Affiliated Hospital of PLA Air Force Military Medical University,Xi'an 710038,China)
出处
《国际泌尿系统杂志》
2021年第6期961-965,共5页
International Journal of Urology and Nephrology
基金
国家自然科学基金(81700666)。
