Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, LeFrak Center of Robotic Surgery and Institute of Prostate Cancer, James Buchanan Brady Foundation, New York, New York 10065, USA.
J Endourol. 2010 Dec;24(12):1975-83. doi: 10.1089/end.2009.0630. Epub 2010 Oct 25.
Creation of an optimally apposed, tension-free, well-supported vesicourethral anastomosis remains the cornerstone for anastomotic healing after radical prostatectomy. We report the effect of three techniques of bladder neck reconstruction during robot-assisted radical prostatectomy on anastomotic leak, stricture formation, and continence recovery.
Between January 2005 to September 2009, 1900 consecutive patients underwent robotic-assisted laparoscopic prostatectomy (RALP) by a single surgeon. Of these, the first 214 underwent vesicourethral conventional anastomosis (CA); the next 303 men underwent anterior reconstruction (AR) only; and last 1383 men underwent total anatomic restoration (TR). Data elements included patient age, body mass index, preoperative biopsy Gleason score and prostate-specific antigen level, prostate volume, total operative time, console time, time for performing vesicourethral anastomosis, estimated blood loss, tumor stage, and margin status on final pathologic findings. Primary end points were rates of clinically significant anastomotic leaks, bladder neck contractures, and time to return of continence. Chi-square and Fisher exact tests were used for analysis of categoric variables. The Cox proportional hazard model was used for both univariate and multivariate analysis.
Clinically significant anastomotic leakage and bladder neck strictures were significantly fewer in the reconstructed groups (2.3% vs 1.0% vs 0.3% and 3.7% vs 1.3% vs 0.5% in the CA, AR, and TR groups, P < 0.01). Continence rates at 1, 6, 12, 26, and 52 weeks after RALP were also significantly better at all time points with AR and TR compared with CA alone (P < 0.001).
TR of the continence mechanism optimizes vesicourethral anastomosis healing and hastens early continence return after RALP.
在根治性前列腺切除术后，创建一个最佳贴合、无张力、充分支撑的膀胱颈-尿道吻合口仍然是吻合口愈合的基石。我们报告了机器人辅助根治性前列腺切除术中三种膀胱颈重建技术对吻合口漏、狭窄形成和控尿恢复的影响。
2005 年 1 月至 2009 年 9 月，由一名外科医生对 1900 例连续患者进行了机器人辅助腹腔镜前列腺切除术（RALP）。其中，前 214 例患者行常规膀胱颈吻合术（CA）；接下来的 303 例患者仅行前重建术（AR）；最后 1383 例患者行完全解剖修复术（TR）。数据元素包括患者年龄、体重指数、术前活检 Gleason 评分和前列腺特异性抗原水平、前列腺体积、总手术时间、控制台时间、行膀胱颈吻合术的时间、估计失血量、肿瘤分期和最终病理检查的切缘状态。主要终点是临床显著吻合口漏、膀胱颈挛缩和恢复控尿的时间。采用卡方检验和 Fisher 精确检验分析分类变量。采用 Cox 比例风险模型进行单变量和多变量分析。
在重建组中，临床显著吻合口漏和膀胱颈狭窄的发生率明显较低（CA、AR 和 TR 组分别为 2.3%、1.0%和 0.3%和 3.7%、1.3%和 0.5%，P <0.01）。与单独 CA 相比，在 RALP 后 1、6、12、26 和 52 周时，AR 和 TR 组的控尿率在所有时间点均显著提高（P <0.001）。
对控尿机制的 TR 优化了膀胱颈-尿道吻合口的愈合，并加速了 RALP 后的早期控尿恢复。
