Matsuyama Hideyasu, Matsumoto Hiroaki, Nagao Kazuhiro, Harada Noriaki, Hara Takahiko, Sakano Shigeru
Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan.
Int J Urol. 2015 Mar;22(3):271-7. doi: 10.1111/iju.12667. Epub 2014 Nov 16.
To determine the feasibility of vesicourethral anastomosis using running suture during retropubic radical prostatectomy and to compare the surgical outcomes of vesicourethral anastomosis using running suture with those of the standard interrupted suture technique.
A total of 60 patients undergoing radical prostatectomy from 2010 to 2012 at the Yamaguchi University Hospital, Japan were included in the present study, and were randomly assigned to vesicourethral anastomosis using running suture (n = 30 patients) or a standard interrupted suture technique group (n = 30 patients). Vesicourethral anastomosis using running suture was carried out with 12-bite sutures using 3-0 poliglecaprone. The primary end-point was the time to catheter removal. Patients' health-related quality of life was assessed using the Expanded Prostate Cancer Index Composite in 56 patients (28 patients in each group).
No significant difference was found in the median suturing time between the two study groups (both 19 min, P = 0.449). The time to catheter removal was significantly better in the vesicourethral anastomosis using running suture group (hazard ratio 5.23, 95% confidence interval 1.73-17.65, P = 0.003). The pad-free rate was significantly higher in the vesicourethral anastomosis using running suture group at 1 month after surgery (20.7% vs 3.3%, P = 0.0463); however, there was no significant difference at 3 months and beyond. The Expanded Prostate Cancer Index Composite urinary and bowel summary scores at 1 month were significantly better in the vesicourethral anastomosis using running suture patients (both P < 0.01), though no significant difference was observed thereafter. A vesicourethral anastomosis stricture was noted in three patients (10%) in the standard interrupted suture technique group, and none in the vesicourethral anastomosis using running suture group.
Running suture for vesicourethral anastomosis is feasible during retropubic radical prostatectomy. Furthermore, it offers better outcomes than the conventional standard interrupted suture technique, with a higher likelihood of improvement in patients' health-related quality of life.
确定耻骨后根治性前列腺切除术中采用连续缝合法进行膀胱尿道吻合的可行性，并比较连续缝合法与标准间断缝合法进行膀胱尿道吻合的手术效果。
本研究纳入了2010年至2012年在日本山口大学医院接受根治性前列腺切除术的60例患者，随机分为连续缝合法膀胱尿道吻合组（n = 30例患者）和标准间断缝合法组（n = 30例患者）。连续缝合法膀胱尿道吻合采用3-0聚乙醇酸进行12针缝合。主要终点是拔除导尿管的时间。使用扩展前列腺癌指数综合量表对56例患者（每组28例）的健康相关生活质量进行评估。
两组研究对象的中位缝合时间无显著差异（均为19分钟，P = 0.449）。连续缝合法膀胱尿道吻合组拔除导尿管的时间明显更短（风险比5.23，95%置信区间1.73 - 17.65，P = 0.003）。术后1个月，连续缝合法膀胱尿道吻合组的无尿垫率显著更高（20.7%对3.3%，P = 0.0463）；然而，3个月及以后无显著差异。连续缝合法膀胱尿道吻合患者术后1个月的扩展前列腺癌指数综合量表泌尿和肠道总结评分明显更好（均P < 0.01），但此后未观察到显著差异。标准间断缝合法组有3例患者（10%）出现膀胱尿道吻合口狭窄，连续缝合法膀胱尿道吻合组无狭窄病例。
耻骨后根治性前列腺切除术中采用连续缝合法进行膀胱尿道吻合是可行的。此外，与传统的标准间断缝合法相比，其效果更好，患者健康相关生活质量改善的可能性更高。
