腹腔镜前列腺癌根治术吻合技术对吻合口并发症的影响

发布时间：2018-07-01 20:17

本文选题：前列腺癌 + 腹腔镜　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：比较腹腔镜前列腺癌根治术中不同的膀胱尿道吻合方式对术后吻合口并发症的影响。方法：2011年2月~2013年9月我科对66例临床局限性前列腺癌实施腹腔镜前列腺癌根治术，手术采用经腹腔入路。患者根据吻合方式不同分为两组，一组24例采用间断缝合的膀胱尿道吻合方式，另一组42例采用连续缝合方式。比较两种手术方法的手术时间、术后吻合口漏尿、拔管后吻合口狭窄及一个月、三个月、六个月的尿失禁情况的差异。结果：66例腹腔镜前列腺癌根治术均获成功，无一例中转开放手术。间断缝合组：尿道膀胱吻合用时27~40min，平均35.7min；出现吻合口漏尿3例，分别于术后3~6天出现，漏尿2~4天后愈合；留置导尿2周拔除尿管后一个月，2例出现排尿困难，再次留置导尿一周后排尿好转；术后一个月随诊15例控尿良好，9例出现尿失禁；三个月随诊19例控尿良好，5例出现尿失禁；六个月随诊21例控尿良好，3例出现尿失禁。连续缝合组：尿道膀胱吻合用时15~25min，平均20.5min；出现吻合口漏尿2例，分别于术后3天、5天出现，漏尿2天后愈合；留置导尿2周拔除尿管后一个月，1例出现排尿困难，再次留置导尿一周后排尿好转；术后一个月随诊33例控尿良好，9例出现尿失禁；三个月随诊40例控尿良好，，2例出现尿失禁；六个月随诊41例均控尿良好，仅1例出现尿失禁。结论：腹腔镜前列腺癌根治术中采用连续缝合的膀胱尿道吻合方式较间断缝合可缩短手术时间，降低吻合口漏尿、吻合口狭窄及尿失禁等并发症的发生率。
[Abstract]:Objective : To compare the effects of different bladder urethral anastomosis on postoperative anastomotic complications in laparoscopic radical prostatectomy .

Methods : From February 2011 to September 2013 , we performed laparoscopic radical prostatectomy for 66 cases of clinical localized prostate cancer . The patients were divided into two groups according to the anastomosis method .

Results : 66 cases of laparoscopic radical prostatectomy were successful and none of them were open to open surgery . The interrupted suture group : 27 to 40 minutes at the time of anastomosis of the urethra bladder , and the average was 35.7min ;
There were 3 cases of anastomotic leakage , 3 - 6 days after operation and 2 - 4 days after leakage .
One month after the urinary catheter was removed after 2 weeks of catheterization , 2 cases had difficulty in urination , and after another week of catheterization , the urination was improved ;
One month after operation , 15 cases were treated with good urine and 9 cases had urinary incontinence ;
Three months follow - up 19 cases with good control of urine , 5 cases of urinary incontinence ;
Twenty - six months follow - up in 21 cases with good control of urine and 3 cases of urinary incontinence . Continuous suture group : 15 - 25 min at the time of anastomosis of urethra bladder , average 20.5 min ;
There were 2 cases of anastomotic leakage , 3 days after operation , 5 days after operation and 2 days after leakage of urine ;
One month after the urinary catheter was removed for 2 weeks , one patient had difficulty in urination , and after another week of catheterization , the urination was improved .
One month after operation , 33 cases had better control of urine and 9 cases had urinary incontinence ;
In the last three months , 40 cases had better control of urine and 2 cases had urinary incontinence ;
There were 41 cases with good control of urine in six months , and only 1 case had urinary incontinence .

Conclusion : The operation time can be shortened and the incidence of complications such as anastomotic leakage , anastomotic stenosis and urinary incontinence can be reduced by continuous suture in laparoscopic radical prostatectomy .
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.25

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