T1期前列腺癌病人根治术中保留尿道长度及血管神经对其术后尿控功能及性生活质量的影响分析

doi:10.3969/j.issn.1005-6483.2021.11.024

摘要/Abstract

摘要： 目的探讨T1期前列腺癌病人根治术中保留尿道长度及血管神经对其术后尿控功能及性生活质量的影响。
方法将我院收治的T1期前列腺癌病人110例分成A组(53例)、B组(57例)。A组行常规腹腔镜手术，B组在腹腔镜下腹膜外保留血管神经束，并最大限度保留尿道长度。比较两组围术期指标。记录两组手术前后尿动力学指标、尿控能力及简明男性性功能量表(BMSFI)评估结果。
结果 B组术中出血量(156.52±12.56)ml显著少于A组的(184.93±10.04)ml，术后下床时间(42.82±6.21)h显著短于A组(49.19±7.84)(P<0.05)。B组术后膀胱顺应性、最大尿道压、最大尿流量、最大逼尿肌压力[(32.31±3.02)cmH2O、(40.09±2.46)cm H2O、(11.65±1.58)ml/s、(17.26±1.85)cm H2O]显著高于A组[(27.93±2.35)cm H2O、(37.29±2.24)cm H2O、(9.29±0.64)ml/s、(13.16±1.10)cm H2O](P<0.05)。B组术后6个月的0级占比52.63%高于术后1个月（29.82%）及A组（39.62%）(P<0.05)。 B组术后组内比较，性欲、勃起功能、射精功能、问题评估、总体满意度评分[(3.26±0.42)分、(8.79±1.01)分、(5.43±0.76)分、(8.79±0.94)分、(1.89±0.23)分]显著低于术前[(3.86±0.73)分、(9.51±2.01)分、(6.23±0.85)分、(9.29±1.41)分、(2.28±0.29)分]，但组间比较显著高于A组术后[(3.08±0.47)分、(8.43±0.74)分、(5.07±0.59)分、(8.34±0.45)分、(1.74±0.21)分]，差异有统计学意义(P<0.05)。
结论前列腺癌病人术中保留血管神经束与尿道长度，可减少术中出血量，术后能尽早下床活动，且能提升术后尿控能力，改善术后性功能。

关键词: 前列腺癌, 保留血管神经束, 尿道长度, 尿控能力, 性功能

Abstract: Objective To investigate the value of preserving urethral length and nerve vessels in radical resection of T1 prostate cancer.
Methods Patients with stage T1 prostate cancer admitted to our hospital were divided into two groups:group A(53 cases) and group B(57 cases)Routine laparoscopic surgery was performed in group A,while vascular and nerve bundles were preserved in group B,and urethral length was preserved to the maximum extent.Perioperative indexes,urodynamic indexes,urinary control ability and BMSFI scores were compared between the two groups.
Results The amount of bleeding and postoperative time of getting out of bed in group B[(156.52±12.56)ml and (42.82±6.21)h] were shorter than that in group A[(184.93±10.04)ml and (49.19±7.84)h](P<0.05).The postoperative bladder compliance,maximum urethral pressure,maximum urinary flow,maximum detrusor pressure and urinary control ability of group B[(32.31±3.02)cmH2O、(40.09±2.46)cm H2O、(11.65±1.58)ml/s、(17.26±1.85)cm H2O] were all superior to group A[(27.93±2.35)cm H2O、(37.29±2.24)cm H2O、(9.29±0.64)ml/s、(13.16±1.10)cm H2O](P<0.05).In group B, the proportion of grade 0 was 52.63% six months after operation, which was higher than that one month after operation（29.82%） and group A（39.62%）(P<0.05).Intra-group comparison after operation in group B,Sexual desire, erectile function, ejaculation function, problem assessment, overall satisfaction rating[(3.26±0.42),(8.79±1.01),(5.43±0.76),(8.79±0.94),(1.89±0.23)] were significantly lower than before surgery[(3.86±0.73),(9.51±2.01),(6.23±0.85),(9.29±1.41),(2.28±0.29)].However, the inter-group comparison was significantly higher than that of group A after surgery[(3.08±0.47),(8.43±0.74),(5.07±0.59),(8.34±0.45),(1.74±0.21)],the difference was statistically significant(P<0.05).
Conclusion Preserving the length of vascular nerve bundle and urethra during surgery can reduce intraoperative blood loss, get out of bed as soon as possible after surgery, and improve postoperative urinary control ability and sexual function.

Key words: prostate cancer, vascular bundle preservation, urethral length, urine control ability, sexual function

王小波骆华廖高源刘琛. T1期前列腺癌病人根治术中保留尿道长度及血管神经对其术后尿控功能及性生活质量的影响分析[J]. 临床外科杂志, 2021, 29(11): 1079-1082.

WANG Xiaobo, LUO Hua, LIAO Gaoyuan, et al.. Effect of urethral length and vascular nerve preservation on urinary control function and quality of sexual life in patients with T1 stage prostate cancer undergoing radical prostatectomy[J]. JOURNAL OF CLINICAL SURGERY, 2021, 29(11): 1079-1082.

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