目的：探讨前列腺体积（prostatic volume，PV）及前列腺突入膀胱长度（intravesical prostatic protrusion length，IPPL）与腹腔镜前列腺癌根治术后控尿功能恢复的相关性。方法：纳入经组织病理学诊断为前列腺腺癌并于北京大学第三医院行腹腔镜前列腺根治性切除术（laparoscopic radical prostatectomy，LRP）的患者88例，磁共振检查均于前列腺穿刺活检术前1周内完成。依据PV将患者分为小体积前列腺组（PV＜50 mL）和大体积前列腺组（PV≥50 mL）；依据IPPL（冠状位测量突入膀胱前列腺组织顶点至膀胱基底部的垂直距离）将患者分为前列腺未明显突入膀胱组（IPPL＜5 mm）和前列腺明显突入膀胱组（IPPL≥5 mm）。术后随访1年并记录患者术后控尿功能的恢复情况。结果：入组患者共88例，LRP手术均顺利完成，手术时间（155±67） min，出血量（145±159） mL。术前磁共振检查测量PV为11.83～151.53 mL，平均（44.54±26.58） mL，其中PV＜50 mL者65例（73.9%），PV≥50 mL者23例（26.1%）；术前磁共振检查测量IPPL为0～27 mm，平均（5.2±5.7） mm，其中IPPL＜5 mm者56例（63.6%），IPPL≥5 mm者32例（36.4%）。LRP术后3、6和12个月随访患者控尿功能恢复情况，完全控尿率分别为53.4%（47/88）、84.1%（74/88）和94.3%（83/88）。PV＜50 mL组和PV≥50 mL组术后3个月完全控尿率组间差异有统计学意义（61.5％ vs. 30.4％，P=0.010）， 6和12个月完全控尿率组间差异无统计学意义（87.7％ vs. 73.9％，P=0.120； 96.9％ vs. 87.0％，P=0.076）。IPPL＜5 mm组与IPPL≥5 mm组术后3、6和12个月完全控尿率组间差异均有统计学意义（66.1％ vs. 31.3％，P=0.002； 92.6％ vs. 68.8％，P=0.003； 98.2％ vs. 87.5％，P=0.037）。采用Kaplan-Meier法绘制PV＜50 mL、≥50 mL组和IPPL＜5 mm、≥5 mm组患者术后控尿功能恢复曲线，Log-rank检验提示PV＜50 mL组术后控尿功能恢复显著优于PV≥50 mL组（P=0.017）， IPPL＜5 mm组术后控尿功能恢复显著优于IPPL≥5 mm组（P=0.001）。结论：术前磁共振检查提示巨大体积前列腺及前列腺明显突入膀胱的前列腺癌患者LRP术后控尿功能恢复延迟，术后早期（3个月）尿失禁的发生率明显增高，在临床工作中应予以重视，此结果还需要更大规模的临床研究证实。

Objective： To assess the relationship between recovery of urinary continence after laparoscopic radical prostatectomy (LRP) and prostatic volume (PV) and intravesical prostatic protrusion length (IPPL) on preoperative magnetic resonance imaging (MRI). Methods: 88 patients with pathologic confirmed prostate carcinoma who were underwent LRP were included in this study. MRI examination was performed in 1 week before the biopsy. The patients were divided into two groups according to PV (＜50 mL, ≥50 mL) on preoperative MRI. The patients were divided into two groups according to IPPL (＜5 mm, ≥5 mm), IPPL was measured on MRI as the vertical distance from the tip of the protru-ding prostate to the base of the urinary bladder. After surgery we recorded and analyzed recovery of urinary continence of the patients for one year. Results: All the 88 patients received extra-peritoneal LRP successfully. The average operation time was (155±67) min, and the estimated blood volume was (145±159) mL. There was a significant difference between group PV＜50 mL and ≥50 mL in the operation time (P=0.045). All the patients who underwent MRI preoperatively showed that their mean PV was (44.54±26.58) mL and mean IPPL was (5.2±5.7) mm. The continence rate for all the patients after LRP was 53.4%, 84.1% and 94.3% in their follow-up of 3, 6 and 12 months. Three months after LRP, the continence rate for group PV＜50 mL and ≥50 mL were 61.5% and 30.4%, which were completely continent (P=0.010). Six or twelve months after surgery, the continence rate was 87.7％ and 73.9％ (P=0.120), 96.9％ and 87.0％ (P=0.076) for group PV＜50 mL and ≥50 mL separately. Three months after LRP, the continence rate for group IPPL＜5 mm and ≥5 mm were 66.1% and 31.3%, which were completely continent (P=0.002). Six months after surgery, the continence rate was 92.6％ and 68.8％ (P=0.003), and one year after surgery, the continence rate was 98.2％ and 87.5％ for group IPPL＜5 mm and ≥5 mm separately (P=0.037). There was a significant difference between group PV＜50 mL and ≥50 mL in the urinary continence curve (P=0.017), and the same significant difference between group IPPL＜5 mm and ≥5 mm (P=0.001). Conclusion: The PV and IPPL on preoperative MRI were associated with significantly slower return of urinary continence, especially for early recovery (3 months) of continence after LRP.