术中保留耻骨前列腺韧带对行机器人辅助腹腔镜前列腺癌根治术老年患者的影响 ^*

The effect of preserving the pubic prostatic ligament during surgery on elderly patients undergoing robot-assisted laparoscopic radical prostatectomy

摘要

目的 探讨术中保留耻骨前列腺韧带对行机器人辅助腹腔镜前列腺癌根治术(RALP)的老年患者术后膀胱功能及尿失禁的影响。方法 选取中国人民解放军联勤保障部队第九六○医院2019年6月—2023年6月接受RALP治疗的80例老年前列腺癌患者进行回顾性分析, 按照手术方案不同分为A组(RALP术中保留耻骨前列腺韧带, 37例)和B组(标准RALP, 43例)。比较两组的围术期相关指标、术后膀胱功能、尿失禁发生情况与严重程度、性功能及生活质量。结果 A组总住院时间短于B组(P<0.05); 两组手术时间、术中出血量、术后引流管留置时间、术后导尿管留置时间比较, 差异均无统计学意义(P>0.05)。随访6个月时, A组最大尿流率、最大尿道压、膀胱顺应性等数据均大于B组, 残余尿量少于B组(P<0.05); A组尿失禁发生率低于B组, 尿失禁严重程度轻于B组(P<0.05); A组勃起功能国际问卷表-5评分、中国早泄患者性功能评价表-10评分、世界卫生组织生活质量测定简表各项评分均高于B组(P<0.05)。结论 老年前列腺癌患者RALP术中保留耻骨前列腺韧带可提高术后膀胱功能, 降低尿失禁发生率, 改善性功能与生活质量, 可促进患者康复。

Abstract

Objective To explore the effect of preserving the pubicprostato ligament (PPLs) during surgery on postoperative bladder function and urinary incontinence in elderly patients undergoing robot-assisted laparoscopic radical prostatectomy (RALP). Methods A total of 80 elderly patients with prostate cancer who received RALP treatment in the the 960th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation from June 2019 to June 2023 were retrospective collected. They were divided into a group A (37 cases, with puboprostatic Ligament preserved during RALP surgery) and a group B (43 cases, with standard RALP surgery) according to different surgical plans. The perioperative related indicators, postoperative bladder function, incidence and severity of urinary incontinence, sexual function, and quality of life between the two groups were collected and compared. Results The total hospitalization time of group A was shorter than that of group B (P<0.05). The differences in the operation time, intraoperative blood loss, postoperative drainage tube indwelling time and postoperative catheter indwelling time between the two groups had no statistical significance (P>0.05). At 6 months follow-up, the maximum urinary flow rate, maximum urethral pressure, and bladder compliance in group A were higher than those in group B and the residual urine volume was lower than that in group B (P<0.05), the incidence of urinary incontinence in group A was lower than that in group B, and the severity of urinary incontinence was milder in group A than in group B (P<0.05), the scores of group A on the international inventory of erectile function-5, Chinese premature ejaculation patient sexual function evaluation scale-10, and World Health Organization quality of life assessment brief were all higher than those of group B (P<0.05). Conclusion Retaining puboprostatic ligament during surgery in elderly patients with RALP can improve postoperative bladder function, reduce the incidence of urinary incontinence, improve sexual function and quality of life, and promote recovery.

关键词

前列腺癌 / 机器人辅助腹腔镜前列腺癌根治术 / 耻骨前列腺韧带 / 膀胱功能 / 尿失禁

Key words

Prostate cancer / Robot-assisted laparoscopic radical prostatectomy / Puboprostatic ligament / Bladder function / Urinary incontinence

参考文献

[1] Sekhoacha M, Riet K, Motloung P, et al. Prostate cancer review: genetics, diagnosis, treatment options, and alternative approaches[J]. Molecules, 2022, 27(17): 5730.

[2] Tilki D, Van Den Bergh R, Briers E, et al. EAU—EANM—ESTRO—ESUR—ISUP—SIOG guidelines on prostate cancer. Part Ⅱ—2024 update: treatment of relapsing and metastatic prostate cancer[J]. Eur Urol, 2024, 86(2): 164-182.

[3] 廖鑫扬, 鲍一歌, 刘振华, 等 . 保留盆底稳定结构合并前方高位逆向松解神经血管束的机器人辅助根治性前列腺切除术功能结局指标分析[J]. 中华外科杂志, 2024, 62(2): 128-134.

[4] Liao X Q , Bao Y G , Liu Z H , et al. Functional outcomes of robot—assisted radical prostatectomy with preservation of pelvic stabilized structure and early elevated retrograde liberation of neurovascular bundle[J]. Chin J Surge, 2024, 62(2): 128-134.

[5] 李金桥, 李卓然, 徐俊楠, 等 . 保留Retzius间隙机器人根治性前列腺切除术与传统前入路机器人根治性前列腺切除术治疗前列腺癌伴中叶突出患者疗效比较[J]. 临床泌尿外科杂志, 2025, 40(1): 6-10, 15.

[6] Li J Q , Li Z R , Xu J N , et al. Comparison of therapeutic effects between robotic radical prostatectomy with retained Retzius gap and traditional anterior approach robotic radical prostatectomy for patients with prostate cancer and middle lobe protrusion[J]. J Clin Urol, 2025, 40(1): 6-10, 15.

[7] 施振凯, 王海峰, 王燕, 等 . SUTURE技术在机器人根治性前列腺切除术中的应用[J]. 中华泌尿外科杂志, 2018, 39(1): 10-13.

[8] Shi Z K , Wang H F , Wang Y , et al. The application of SUTURE technique in robotic—assisted radical prostatectomy[J]. Chin J Urol, 2018, 39(1): 10-13.

[9] 赵达 . 现代肿瘤学[M]. 北京: 科学出版社, 2021: 271.

[10] Zhao D . Modern Oncology[M]. Beijing: Science Press, 2021: 271.

[11] 司龙妹, 丁炎明, 黄燕波, 等 . 腹腔镜前列腺癌根治术后患者尿失禁发生状况及与生活质量的相关性分析[J]. 中华现代护理杂志, 2019, 25(15): 1946-1950.

[12] Shi L M , Ding Y M , Huang Y B , et al. Correlation between urinary incontinence and quality of life among patients with post—laparoscopic radical prostatectomy[J]. Chin J Mod Nurs, 2019, 25(15): 1946-1950.

[13] Vallejo—medina P, Saffon J P, Álvarez—muelas A . Colombian clinical validation of the international index of erectile function (IIEF—5)[J]. Sex Med, 2022, 10(1): 100461.

[14] 王宁华, 苏元华, 董锐, 等 . 心理治疗联合盐酸舍曲林治疗早泄效果及对患者性生活满意度的影响[J]. 中国性科学, 2017, 26(2): 10-12.

[15] Wang N H , Su Y H , Dong R , et al. Psychotherapy joint with sertraline hydrochloride in treating premature ejaculation and its influence on patients' sexual satisfaction[J]. Chin J Human Sexual, 2017, 26(2): 10-12.

[16] 武敬参, 鄢秀英, 王羽, 等 . 健康调查简表与世界卫生组织生存质量测定量表简表在评价肺结核患者生存质量中的应用比较[J]. 华西医学, 2016, 31(3): 463-466.

[17] Wu J C , Yan X Y , Wang Y , et al. Comparative evaluation of the 36—Item Short Form Health Survey and the World Health Organization Quality of Life—bref in patients with pulmonary tuberculosis[J]. West China Med J, 2016, 31(3): 463-466.

[18] Eastham J A, Auffenberg G B, Barocas D A, et al. Clinically localized prostate cancer: AUA/ASTRO guideline, part Ⅰ: introduction, risk assessment, staging, and risk—based management[J]. J Urol, 2022, 208(1): 10-18.

[19] Hakozaki K, Takeda T, Yasumizu Y, et al. Predictors of urinary function recovery after laparoscopic and robot—assisted radical prostatectomy[J]. Int Braz J Urol, 2023, 49(1): 50-60.

[20] Ippoliti S, Colalillo G, Egbury G, et al. Continence—sparing techniques in radical prostatectomy: a systematic review of randomized controlled trials[J]. J Endourol, 2023, 37(10): 1088-1104.

[21] 何威, 邢思伟, 徐丹枫, 等 . 局限性前列腺癌行保留膀胱颈的腹腔镜根治性前列腺切除术对控尿的影响[J]. 临床泌尿外科杂志, 2024, 39(7): 567-570.

[22] He W , Xing S W , Xu D F , et al. Impact of bladder neck preservation on continence in laparoscopic radical prostatectomy for localized prostate cancer[J]. J Clin Urol, 2024, 39(7): 567-570.

[23] 徐文浩, 刘良, 邓旻, 等 . 达芬奇机器人辅助最大程度保留周围结构的前列腺癌根治术的临床研究[J]. 重庆医学, 2024, 53(18): 2776-2780.

[24] Xu W H , Liu L , Den G M , et al. Clinical study on Da Vinci Robot—assisted prostate cancer radical operation with maximal preservation of periprostatic structures[J]. Chongqing Med, 2024, 53(18): 2776-2780.

[25] 王明帅, 熊天宇, 蒋铭心, 等 . 改良前列腺尖部分离技术保留尿道周围结构对前列腺癌根治术后即刻尿控的影响[J]. 首都医科大学学报, 2021, 42(6): 973-977.

[26] Wang M S , Xiong T Y , Jiang M X , et al. The effect of modified apical dissection and periurethral structure preservation in the immediate continence recovery after laparoscopic radical prostatectomy[J]. J Capital Med Univ, 2021, 42(6): 973-977.

[27] 丁思伟, 代坤含, 秦梓榛, 等 . 机器人辅助腹腔镜下前列腺癌根治术中保留耻骨前列腺韧带对尿控恢复的影响[J]. 重庆医学, 2023, 52(22): 3419-3424.

[28] Ding S W , Dai K H , Qin Z Z , et al. Effect of preserving puboprostatic ligament on urinary continence recovery during robot—assisted laparoscopic radical prostatectomy for prostate cancer[J]. Chongqing Med, 2023, 52(22): 3419-3424.

[29] 李涛, 孙欣, 殷锋彦, 等 . PPLs对RARP患者术后尿控恢复的影响[J]. 国际泌尿系统杂志, 2024, 44(6): 985-988.

[30] Li T , Sun X , Yin F Y . Effect of preserving the puboprostatic ligament on urinary control recovery after radical laparoscopic resection of prostate cancer[J]. Int J Urol Nephrol, 2024, 44(6): 985-988.

[31] Shimmura H, Banno T, Nakamura K, et al. A single—center retrospective comparative analysis of urinary continence in robotic prostatectomy with a combination of umbilical ligament preservation and Hood technique[J]. Int J Urol, 2023, 30(10): 889-895.

[32] Huang J, Dai X, Sun J, et al. Prediction models for urinary incontinence after robotic—assisted laparoscopic radical prostatectomy: a systematic review[J]. J Robot Surg, 2024, 18(1): 249.

[33] 赵长剑, 刘艳芳, 任力娟 . 机器人辅助腹腔镜前列腺癌根治术中保留耻骨前列腺韧带对患者排尿控制功能及生活质量的影响[J]. 临床和实验医学杂志, 2024, 23(18): 1957-1961.

[34] Zhao C J , Liu Y F , Ren L J . Effect of preserving the pubic prostate ligament on urinary control and quality of life during robot assisted laparoscopic radical prosta—tectomy for prostate cancer[J]. J Clin Exp Med, 2024, 23(18): 1957-1961.

[35] 郑坤, 胡晓勇, 傅强, 等 . 腹腔镜下前列腺癌根治术联合保留最大尿道长度和膀胱颈的尿道重建术治疗高危前列腺癌的早期控尿和控瘤效果[J]. 现代泌尿外科杂志, 2024, 29(7): 612-616.

[36] Zheng K , Hu X Y , Fu Q , et al. Laparoscopic surgery for high—risk prostate cancer: urinary and oncologic outcomes of vesicourethral anastomosis with maximal urethral length and bladder neck preservation[J]. J Modern Urol, 2024, 29(7): 612-616.

基金资助

^*国家自然科学基金(81572875)