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LRP术后膀胱颈后尿道吻合口狭窄发生的危险因素分析及防治
The analysis and management of vesicourethral anastomotic stricture after laparoscopy radical prostatectomy

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DOI:
作者:
李腾成,邱剑光，周祥福，李辽源，陈明坤，高新
Teng-Cheng Li, Jian-Guang Qiu, Xiang-Fu Zhou,
作者单位:
中山三院
Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University
关键词:
前列腺癌；腹腔镜；前列腺癌根治术；吻合口狭窄
Prostate cancer(PCa); laparoscopy; radical prostatectomy(RP); Anastomotic stricture(AS)
摘要:
目的：探讨LRP术后膀胱颈后尿道吻合口狭窄发生的危险因素分析及防治体会。 方法：2006年1月至2009年6月，150例LRP术后患者临床病例资料。Logistic 回归分析患者起病年龄、术前总前列腺特异性抗原值，术中失血量、膀胱颈后尿道吻合方法，术后病理分期、导尿管留置时间、拔除导尿管后尿白细胞计数与术后吻合口狭窄发生的关系。结果：150例LRP患者中，8例术后诊断为膀胱颈后尿道吻合口狭窄，发生率为5.33%。LRP后导尿管留置时间及拔除导尿管后尿白细胞计数差异与膀胱颈后尿道吻合口狭窄的发生具有统计学意义（OR7.98, 95%CI2.38-15.57, p=0.038; OR6.38, 95%CI2.28-22.53, p=0.019）。但患者起病年龄，术前总前列腺特异性抗原值，术中失血量，膀胱尿道吻合方法，术后病理分期与吻合口狭窄的发生均无明显统计学差异（P>0.05）。3例吻合口狭窄患者经定期尿道扩展治愈，5例吻合口狭窄患者经尿道镜狭窄环冷刀切开+瘢痕电切术治愈。结论：导尿管留置时间和拔除导尿管后尿白细胞计数是LRP术后膀胱颈尿道吻合口狭窄发生的独立危险因素。定期尿道扩张和经尿道镜狭窄环冷刀切开+瘢痕电切术是解决吻合口狭窄安全、有效的方法。
Objectives: To analyse the potential factors contributing to vesicourethral anastomotic stricture (AS) after laparoscopy radical prostatectomy(LRP) and the efficacy of management. Materials and methods: A total of 150 patients with LRP were recorded between January 2006 to June 2009. Multivariate logistic regression analysis using the stepwise backward procedure was performed to identify whether age, pre-operation prostate specific antigen, intraoperative estimated blood loss, anastomosis method, pathological stage, catheter duration and post-operative pyuria had significant associations with AS. Results: 8 of the 150 patients(5.33%) developed an AS during the follow-up. Catheter duration and Post-operative pyuria were identified as significant risk factors for AS after LRP(OR7.98, 95%CI2.38-15.57, p=0.038; OR6.38, 95%CI2.28-22.53, p=0.019; respectively). However, age, pretreatment prostate specific antigen, intraoperative estimated blood loss, anastomosis method and pathological stage were not identified as significant risk factors for AS in the multivariate logistic regression model (all p values > 0.05). 3 patients were successfully managed by urethral sounding dilation only, whereas 5 patients required cold-knife incision (CKI). Conclusions: Our data suggest that catheter duration and post-operative pyuria are significant risk factors contributing to AS formation after LRP. AS can be effectively managed with repeated urethral sounding dilation or CKI.

 

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