根治性前列腺切除术后尿控功能的评价与影响因素分析

发布时间：2018-06-06 14:09

本文选题：前列腺癌 + 前列腺切除术　；参考：《苏州大学》2014年硕士论文

【摘要】：目的尿失禁是根治性前列腺切除术后常见并发症之一，也是影响患者术后生活质量的重要因素，本课题目的在于评价根治性前列腺切除术后患者的尿控功能，同时从客观临床因素、手术技术、术后功能锻炼等方面研究相关影响因素。方法2007年6月至2013年6月，我院对术前TNM分期为T1c-T2c的153例前列腺癌患者进行根治性手术（耻骨后根治性前列腺切除术(RRP)55例、腹腔镜根治性前列腺切除术(LRP)98例），回顾所有患者的临床资料，随访术后尿控情况，评价尿控功能，采用单变量和多变量分析对可能影响因素进行统计分析。结果153例手术均获成功。术后4周、12周，RRP组和LRP组尿控率分别为12.7%（7/55）、69.1%（38/55）；17.3%（17/98）、74.5%（73/98）。12周以后，两组手术尿控率基本持平，至术后48周，两组尿控率分别为92.7%（51/55）和93.9%（92/98）。多因素分析结果显示影响尿控恢复的主要因素有：患者手术时年龄（P=0.012）、既往经尿道前列腺电切术（TURP）（P=0.005）、术前新辅助内分泌治疗（NHT）（P=0.022）、前列腺体积（P=0.039）和术中保留血管神经束（NVB）（P=0.002）。结论根治性前列腺切除术后绝大部分患者均能在48周内恢复尿控，且恢复为渐进式，术后4-12周恢复速度最快，LRP后患者早期尿控恢复率较RRP高，而两组手术远期具有相似的尿控效果。手术时年龄、既往TURP和术中保留NVB为影响术后尿控的独立因素，术前NHT和前列腺体积的大小也对术后尿控恢复有影响。
[Abstract]:Objective urinary incontinence is one of the common complications after radical prostatectomy and an important factor affecting the quality of life after prostatectomy. At the same time, the related factors were studied from the aspects of objective clinical factors, surgical techniques, postoperative functional exercise and so on. Methods from June 2007 to June 2013, our hospital performed radical surgery (55 cases of posterior radical prostatectomy) with TNM staging as T1c-T2c. Laparoscopic radical prostatectomy (LRP) was performed in 98 patients. The clinical data of all patients were reviewed, the control status of urine was followed up, the function of urinary control was evaluated, and the possible influencing factors were analyzed by univariate and multivariate analysis. Results 153 cases were successfully operated. After 4 weeks and 12 weeks after operation, the urinary control rates of RRP group and LRP group were 12.775 / 55 / 69.1and 38 / 55 / 17.3 / 74.573 / 98 / 12 respectively. After 12 weeks of operation, the urinary control rate of the two groups was basically unchanged, and by 48 weeks after operation, the urinary control rates in the two groups were 92.775 / 555) and 93.992 / 98 / 993 / 98, respectively. The results of multivariate analysis showed that the main factors affecting the recovery of urinary control were: the age of the patient was 0.012 at the time of operation, the transurethral resection of the prostate (TURP) was performed, the neoadjuvant endocrine therapy before operation was NHTP 0.022, the prostate volume was 0.039) and the Vascular and nerve bundles were preserved during operation. Conclusion the majority of patients after radical prostatectomy can recover urinary control within 48 weeks, and the recovery rate of early urinary control is higher than that of RRP at 4-12 weeks after radical prostatectomy. The two groups had similar urinary control effect in long term. Age of operation, previous TURP and preservation of NVB during operation were independent factors affecting postoperative urinary control. Preoperative NHT and volume of prostate also affected the recovery of postoperative urinary control.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.8

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