Huang Jian Lin, Ma Lu Lin, Huang Yi, Hou Xiao Fei, Wang Guo Liang, Hong Kai, Lu Jian, Xiao Chun Lei
Department of Urology, Peking University Third Hospital, Beijing, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2012 Aug 18;44(4):563-7.
To evaluate urinary continence outcomes after laparoscopic radical prostatectomy (LRP), and explore the learning curve for continence.
Between May 2006 and May 2011, 200 consecutive patients with clinically localized prostate cancer underwent LRP in Peking University Third Hospital, of whom 160 were performed by a single surgeon and followed up successfully. The average age was (71.9±5.5) years (their age range: 56 to 85 years). All the patients were continent before operation. Of these patients, 11 had undergone previous transurethral resection of the prostate (TURP) and the other 149 were diagnosed by transrectal prostate biopsy. No metastasis was found before surgery. The data about the patients and the operations were recorded. The time from operation till urinary continence was obtained and accessed by interviews. Continence was defined as the use of no pad and no urinary leakage or loss of a few drops occasionally. The patients were divided into 4 equal groups in the 40 consecutive series to determine whether continence was statistically different in group A (1-40) as compared with the other groups.
All the operations were performed laparoscopically without any conversion to open surgery. The mean operative duration was (230±57) min (ranging from 110 to 493 min), the median estimated blood loss was 200 mL (ranging from 30 to 1 200 mL), 12 patients (7.5%) received blood transfusions intraoperatively, and the average hospital stay after surgery was (11.8±7.9) d (ranging from 5 to 60 days). The distribution of pathologic stages was as follows: T2a 20%, T2b 16.9%, T2c 40%, T3a 15%, T3b 5.6% and T4 2.5%. The overall positive surgical margin (PSM) rate was 32.5%. The overall continence rates (no pad) were 14.4% after 1 month, 48.8% after 3 months, 77.5% after 6 months and 86.3% after 12 months. At the end of the follow-up, 21 patients (13.1%) were still incontinent . There was a significant difference in continence between the early (Group A) and later groups (P<0.05).
Continence results after LRP were encouraging, which were comparable to the results in previously published open series. Continence could be improved with increasing surgical experience, and it takes 40-50 cases to reach a plateau for surgeons who have some experiences of laparoscopic operations.
评估腹腔镜根治性前列腺切除术（LRP）后的尿失禁结局，并探讨尿失禁的学习曲线。
2006年5月至2011年5月，200例临床局限性前列腺癌患者在北京大学第三医院接受了LRP，其中160例由单一外科医生实施并成功随访。平均年龄为（71.9±5.5）岁（年龄范围：56至85岁）。所有患者术前均为控尿状态。这些患者中，11例曾接受经尿道前列腺切除术（TURP），另外149例经直肠前列腺活检确诊。术前未发现转移。记录患者及手术相关数据。通过访谈获取手术至尿失禁的时间。尿失禁定义为无需使用尿垫且无尿液漏出或偶尔仅有几滴尿液漏出。将患者按连续的40例为一组分为4组，以确定A组（1 - 40例）与其他组在尿失禁方面是否存在统计学差异。
所有手术均通过腹腔镜完成，无中转开放手术。平均手术时间为（230±57）分钟（范围为110至493分钟），术中估计失血量中位数为200毫升（范围为30至1200毫升），12例患者（7.5%）术中接受输血，术后平均住院时间为（11.8±7.9）天（范围为5至60天）。病理分期分布如下：T2a 20%，T2b 16.9%，T2c 40%，T3a 15%，T3b 5.6%，T4 2.5%。手术切缘阳性（PSM）总体发生率为32.5%。术后1个月总体控尿率（无需使用尿垫）为14.4%，3个月时为48.8%，6个月时为77.5%，12个月时为86.3%。随访结束时，21例患者（13.1%）仍存在尿失禁。早期（A组）与后期组在尿失禁方面存在显著差异（P<0.05）。
LRP后的尿失禁结果令人鼓舞，与先前发表的开放手术系列结果相当。随着手术经验的增加，尿失禁情况可得到改善，对于有腹腔镜手术经验的外科医生而言，需要完成40 - 50例手术才能达到平台期。
