机器人辅助根治性前列腺切除术中保留盆底稳定结构的中长期尿控效果分析^*

Mid- to Long-Term Urinary Continence Outcomes of Pelvic-Peritoneal Structure-Sparing Technique in Robot-Assisted Radical Prostatectomy

摘要

目的 探讨以保留盆底稳定结构为核心的PPSS（pelvic-peritoneal structure-sparing）技术对机器人辅助根治性前列腺切除术（robot-assisted radical prostatectomy, RARP）后尿控功能恢复的中长期影响。方法 本研究为单中心回顾性队列研究，纳入2017年10月–2018年5月期间由同一术者行RARP的82例患者。根据手术方式分为PPSS组（n=53）与非PPSS组（n=29），两组患者基线资料具有可比性。非PPSS组采用标准术式；PPSS组通过保留盆底结构及尖部冷刀分离保护尿道功能。术后随访最长7年，以每日使用0～1片护垫定义为尿控恢复，评估时间点为术后3个月、6个月、1年、2年及截至2025年7月的末次随访。采用Kaplan-Meier法比较两组尿控恢复率，并采用Cox回归分析影响因素。结果 中位随访时间为1 178 d（范围1～2 743 d）。术后3个月和6个月，PPSS组尿控恢复率分别为71.6%和75.4%，高于非PPSS组的44.8%和48.2%（P=0.030, P=0.025）；术后1年及以后两组恢复率差异无统计学意义。多因素Cox回归分析显示，PPSS术式〔风险比（hazard ratio, HR）=2.59，95%置信区间（confidence interval, CI）：1.39～4.81，P=0.002〕和年龄（HR=0.94，95%CI：0.91～0.97，P=0.001）是尿控恢复的独立预测因素。结论 PPSS技术在不增加阳性切缘率的前提下可改善患者术后早期尿控，尽管对长期尿控无显著优势，但仍有助于提升患者术后生活质量，具有一定的临床价值。

Abstract

Objective To evaluate the mid- to long-term effects of the pelvic-peritoneal structure-sparing (PPSS) technique, which aims to preserve the stability of pelvic floor structures, on urinary continence recovery after robot-assisted radical prostatectomy (RARP). Methods This single-center retrospective cohort study included 82 patients who underwent RARP between October 2017 and May 2018, all operated on by the same surgeon. Patients were divided into a PPSS group (n = 53) and a non-PPSS group (n = 29). Standard RARP was performed in the non-PPSS group, whereas the PPSS group involved preservation of pelvic floor structures and cold-knife apical dissection for urethral function protection. Baseline characteristics were comparable between the two groups. Follow-up lasted up to 7 years. Urinary continence was defined as the use of 0-1 pad per day and was assessed at 3, 6, 12, 24 months postoperatively and at the last follow-up (July 2025). Kaplan-Meier analysis and Cox regression were used to compare continence recovery rates and identify influencing factors. Results The median follow-up duration was 1 178 days (range: 1-2 743 days). The PPSS group had significantly higher continence recovery rates at 3 and 6 months (71.6% and 75.4%) compared with the non-PPSS group (44.8% and 48.2%; P = 0.030 and P = 0.025, respectively), while no significant difference was observed at 12 months and thereafter. Multivariate Cox regression analysis showed that the PPSS technique (hazard ratio [HR] = 2.59, 95% CI: 1.39-4.81,P = 0.002) and age (HR = 0.94, 95% CI: 0.91-0.97, P = 0.001) were independent predictors of continence recovery. Conclusion The PPSS technique improves early postoperative urinary continence without increasing the rate of positive surgical margins. Although it does not significantly enhance long-term continence, it may still contribute positively to patients' postoperative quality of life.

关键词

前列腺癌 / 机器人辅助根治性前列腺切除术 / 盆底结构 / 尿控恢复 / PPSS技术

Key words

Prostate cancer / Robot-assisted radical prostatectomy / Pelvic-peritoneal structure / Urinary continence recovery / PPSS technique

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基金资助

*国家重点研发计划项目(2022YFC3602902)