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目的观察保留部分近端前列腺部尿道的腹腔镜前列腺癌根治术对早期尿失禁的影响,探讨其临床应用价值。方法选择绍兴市人民医院于2013年6月—2015年3月收治的72例前列腺癌患者,均符合手术指证,按照配对分组法分为2组,每组36例,对照组采用非保留部分近端前列腺部尿道的前列腺癌根治术,观察组采取保留部分近端前列腺部尿道的腹腔镜前列腺癌根治术治疗,分离前列腺尖部及尿道交界处,术者于前列腺尖部使用小纱布分离玻璃球剥离出0.5~1.0 cm长的尿道。2组患者术后均行抗感染治疗。72例患者均随访12个月。比较2组早期尿失禁的发生情况。结果观察组患者手术时间、术中出血量、住院时间及导尿管留置时间分别为(145.2±42.7)min、(415.2±91.2)ml、(11.2±2.2)d及(15.3±2.6)d,与对照组(139.8±35.8)min、(398.5±98.6)ml、(10.9±1.9)d及(14.5±2.5)d比较差异均无统计学意义,均P>0.05。观察组术后1、3、6个月达到完全尿控率分别为19例(52.8%)、31例(86.1%)、32例(88.9%),均显著高于对照组的8例(22.2%)、16例(44.4%)、25例(69.4%),P<0.05。观察组术后1、3、6个月ICIQ-SF评分均显著低于对照组,P<0.05。结论保留部分近端前列腺部尿道的腹腔镜前列腺癌根治术患者早期尿控效果更佳,具有重要的临床价值。
Objective To observe the effect of laparoscopic radical prostatectomy with preservation of part of proximal urethra on urinary incontinence and to explore its clinical value. Methods Seventy-two patients with prostate cancer who were admitted to Shaoxing People’s Hospital from June 2013 to March 2015 were enrolled in this study. All patients were divided into two groups according to the matching grouping method, 36 cases in each group. The control group was treated with non-reserved part Prostate radical prostatectomy of the urethra, the observation group to retain part of the proximal urethra of the prostate of laparoscopic radical prostatectomy, the separation of the tip of the prostate and urethra junction, the surgeon at the tip of the prostate using a small gauze isolated glass ball Peel 0.5-1.0 cm long urethra. Two groups of patients were treated with anti-infective therapy. All 72 patients were followed up for 12 months. The incidence of early urinary incontinence in two groups was compared. Results The operation time, intraoperative blood loss, hospital stay and urinary catheter retention time in the observation group were (145.2 ± 42.7) min, (415.2 ± 91.2) ml, (11.2 ± 2.2) d and (15.3 ± 2.6) d, respectively Compared with the control group (139.8 ± 35.8) min, (398.5 ± 98.6) ml, (10.9 ± 1.9) d and (14.5 ± 2.5) d, there was no significant difference (all P> 0.05). The complete urinary control rates in observation group were 19 cases (52.8%), 31 cases (86.1%) and 32 cases (88.9%) at 1, 3 and 6 months after operation, respectively, which were significantly higher than those in control group %), 16 cases (44.4%), 25 cases (69.4%), P <0.05. ICIQ-SF scores in observation group at 1, 3 and 6 months after operation were significantly lower than those in control group (P <0.05). Conclusions Laparoscopic radical prostatectomy, which preserves some of the proximal urethra, has better early urinary control and has important clinical value.