腹腔鏡下前列腺癌根治術(shù)聯(lián)合保留最大尿道長(zhǎng)度和膀胱頸的尿道重建術(shù)治療高危前列腺癌的早期控尿和控瘤效果

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Laparoscopic surgery for high-risk prostate cancer：urinary and oncologic outcomes of vesicourethral anastomosis with maximal urethral length and bladder neck preservation

ZHENG Kun，HU Xiaoyong，F(xiàn)U Qiang，LI Wang，WANG Ying，CAO Nailong，CHEN Jiasheng，YANG Ranxing

（Department of Urology，Shanghai Sixth Peoples Hospital Affiliated to Shanghai Jiaotong University School of Medicine，Shanghai 200233，China）

ABSTRACT：Objective To explore the application value of vesicourethral anastomosis with maximal urethral length preservation （MULP） and bladder neck preservation （BNP） in laparoscopic radical prostatectomy （LRP） or robot-assisted laparoscopic radical prostatectomy （RALP） for high-risk prostate cancer （HRPC） in terms of early urinary continence and oncology.

Methods Clinical data of 23 HRPC patients who underwent LRP （including RALP） with MULP and BNP in our hospital during May 2022 and Jan.2024 were retrospectively analyzed.Patients basic information，surgical parameters，postoperative complications，oncological outcomes and urinary incontinence were collected and analyzed.Results All operations were completed successfully without conversion to open surgery.The operation time was （108±31） min，average blood loss （112±45） mL，hospital stay （5.5±1.5） days，urethral catheterization time （12.6±1.8） days，and no patient received blood transfusion during operation.The urinary continence rates at the time of catheter removal，and at 1，3，and 6 months after surgery were 39.1%，65.2%，73.9%，and 91.3%，respectively.Two patients had positive margins，both of which were at the neurovascular bundle.No patient developed surgery-related complications，urinary obstruction or fistula after surgery.Conclusion Vesicourethral anastomosis with MULP and BNP in LRP for HRPC can effectively improve patients early urinary continence rate and postoperative quality of life without increasing the oncological risk.

KEY WORDS：prostate cancer; laparoscopic radical prostatectomy; robot-assisted laparoscopic radical prostatectomy; urinary incontinence; maximal urethral length; bladder neck; vesicourethral anastomosis; urethral reconstruction

摘要：目的 探討聯(lián)合施行保留最大尿道長(zhǎng)度（MULP）和膀胱頸（BNP）的尿道重建術(shù)與腹腔鏡下前列腺癌根治術(shù)（LRP）或機(jī)器人輔助腹腔鏡下前列腺癌根治術(shù)（RALP）治療高危前列腺癌（HRPC）的早期控尿及控瘤效果。（剩余14183字）