前列腺尖部深度与腹腔镜前列腺癌根治术后早期控尿功能恢复的相关性

doi:10.19723/j.issn.1671-167X.2021.04.012

摘要/Abstract

摘要：

目的: 探讨术前前列腺尖部深度(prostate apex depth,PAD)与腹腔镜前列腺癌根治术(laparoscopic radical prostatectomy,LRP)后早期(3个月)控尿功能恢复的相关性。方法: 本组184例患者均经前列腺穿刺活检诊断为前列腺腺癌并于北京大学第三医院泌尿外科行LRP手术,前列腺穿刺活检前均完善MRI检查,将PAD定义为MRI矢状位前列腺尖部至耻骨上缘水平线的垂直距离,将前列腺尖部深度比(PAD ratio,PADR)定义为PAD/耻骨上缘与下缘水平线间的垂直距离(耻骨高度)。所有患者均行腹膜外LRP,自术后第一个月起每月对患者的控尿功能恢复情况进行随访,以全天不需要使用尿垫为控尿功能恢复标准。应用Logistic多因素回归分析影响术后早期控尿功能恢复的危险因素,Log-rank检验比较各组间术后控尿功能恢复曲线的统计学意义。结果: 184例患者平均年龄(69.0±7.7)岁,平均体重指数(25.07±3.29) kg/m²,平均穿刺前前列腺特异性抗原(16.80±21.99) μg/L,穿刺Gleason评分6分、7分和≥8分者分别为14例(7.6%)、81例(44.0%)和89例(48.4%),临床分期T1/T2期157例(85.3%)、T3期27例(14.7%)。术前MRI测量平均前列腺体积(prostatic volume,PV)为(39.35±25.25) mL,平均膜性尿道长度(membranous urethral length,MUL)为(14.0±3.7) mm;PAD为15~40 mm,平均(24.52±4.97)mm;PADR为0.42~1.00,平均0.70±0.14。所有患者手术均顺利完成,随访3个月和12个月完全控尿率分别为62.0%(114/184)和96.2%(177/184);术后早期(3个月)尿失禁的单因素分析中,PV(P=0.049)、MUL(P<0.001)和PADR(P=0.005)具有统计学意义,被纳入多因素分析;多因素分析结果显示,MUL<14 mm(P<0.001)和PADR≥0.70(P=0.032)是术后早期尿失禁发生的独立危险因素。采用Kaplan-Meier法绘制不同PV、MUL和PADR患者术后控尿功能恢复曲线,Log-rank检验示不同PV(P=0.001)、MUL(P<0.001)和PADR(P<0.001)分组控尿功能恢复的差异具有统计学意义。结论: MUL、PADR、PV与LRP术后控尿功能恢复存在相关性,术前MUL较短和PADR较高是术后早期尿失禁发生的独立危险因素。

关键词: 前列腺切除术, 腹腔镜检查, 尿失禁, 前列腺尖部深度

Abstract:

Objective: To evaluate the relationship between recovery of urinary continence after laparoscopic radical prostatectomy (LRP) and preoperative prostate apex depth (PAD) on magnetic resonance imaging (MRI). Methods: We retrospectively analyzed 184 patients with pathologic confirmed prostate carcinoma who underwent LRP in Department of Urology, Peking University Third Hospital. All the patients received MRI examination before surgery. Membranous urethral length (MUL) was defined as the distance from the apex of prostate to the level of the urethra at penile bulb on the coronal image. PAD was defined as the distance from the apex of prostate to the suprapubic ridge line on sagittal MRI. PAD ratio (PADR) was defined as PAD/pubic height. All the patients received extraperitoneal LRP. The patients’ reporting freedom from using safety pad (0 pad/d) were defined as urinary continence. Univariate and multivariate regression analyses were used to identify independent predictors of early continence recovery after LRP. Kaplan-Meier analyses and log-rank test were used to compare time to continence recovery between the groups. Results: For all the 184 patients, the average age was (69.0±7.7) years, the ave-rage mass index(BMI) was (25.07±3.29) kg/m², and the pre-biopsy PSA was (16.80±21.99) g/L. For all the patients who underwent MRI preoperatively, the mean PV was (39.35±25.25) mL and the mean MUL was (14.0±3.7) mm. The mean PAD was (24.52±4.97) mm and the mean PADR was 0.70±0.14. The continence rate for all the patients after LRP was 62.0% and 96.2% in three months and one year. The patients achieving early continence recovery had significant smaller PV (P=0.049), longer MUL (P<0.001) and higher PADR (P=0.005). Multivariate analysis revealed MUL (P<0.001) and PADR (P=0.032) were predictors of continence recovery after LRP. Kaplan-Meier analyses and Log-rank test revealed that MUL (≥14 mm vs. <14 mm, P<0.001) and PADR (≥0.70 vs. <0.70, P<0.001), PV(<50 mL vs. ≥50 mL, P=0.001) were all significantly associated with continence recovery. Conclusion: MUL and PADR are independent predictors of early continence recovery after LRP. MUL, PADR and PV are significantly associated with recovery of urinary continence.

Key words: Prostatectomy, Laparoscopy, Urinary incontinence, Prostate apex depth

中图分类号:

R737.25

张帆,黄晓娟,杨斌,颜野,刘承,张树栋,黄毅,马潞林. 前列腺尖部深度与腹腔镜前列腺癌根治术后早期控尿功能恢复的相关性[J]. 北京大学学报（医学版）, 2021, 53(4): 692-696.

ZHANG Fan,HUANG Xiao-juan,YANG Bin,YAN Ye,LIU Cheng,ZHANG Shu-dong,HUANG Yi,MA Lu-lin. Relationship between prostate apex depth and early recovery of urinary continence after laparoscopic radical prostatectomy[J]. Journal of Peking University (Health Sciences), 2021, 53(4): 692-696.

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参考文献 19

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Items	Incontinence (n=70)	Continence (n=114)	χ²	P
Age			1.409	0.235
≥70 years	37 (52.9)	50 (43.9)
<70 years	33 (47.1)	64 (56.1)
BMI			0.507	0.477
≥25 kg/m²	30 (42.9)	55 (48.2)
<25 kg/m²	40 (57.1)	59 (51.8)
Pre-biopsy PSA			0.564	0.754
<10 μg/L	28 (40.0)	52 (45.6)
10-20 μg/L	22 (31.4)	33 (28.9)
>20 μg/L	20 (28.6)	29 (25.4)
Biopsy Gleason score			2.507	0.286
6	5 (7.1)	9 (7.9)
7	26 (37.1)	55 (48.2)
≥8	39 (55.7)	50 (43.9)
Clinical stage			2.560	0.110
T1/T2	56 (80.0)	101 (88.6)
T3	14 (20.0)	13 (11.4)
PV			3.886	0.049
<50 mL	49 (70.0)	94 (82.5)
≥50 mL	21 (30.0)	20 (17.5)
Pre-operative MUL			33.828	<0.001
<14 mm	53 (75.7)	36 (31.8)
≥14 mm	17 (24.3)	78 (68.4)
PADR			7.893	0.005
<0.70	30 (42.9)	73 (64.0)
≥0.70	40 (57.1)	41 (36.0)

	B	SE	Wald	df	Significance	Exp(B)
PV	-0.576	0.405	2.022	1	0.155	0.562
MUL	-1.861	0.351	28.105	1	<0.001	0.156
PADR	-0.739	0.345	4.594	1	0.032	0.478
Constant	1.522	0.454	11.252	1	<0.001	4.582