北京大学学报(医学版) ›› 2021, Vol. 53 ›› Issue (4): 692-696. doi: 10.19723/j.issn.1671-167X.2021.04.012
ZHANG Fan,HUANG Xiao-juan,YANG Bin,YAN Ye,LIU Cheng,ZHANG Shu-dong,HUANG Yi(),MA Lu-lin
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。
中图分类号:
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