Utility of transrectal ultrasonography guidance and seven key elements of operative skill for early recovery of urinary continence after laparoscopic radical prostatectomy.
Utility of transrectal ultrasonography guidance and seven key elements of operative skill for early recovery of urinary continence after laparoscopic radical prostatectomy.
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DOI：
10.3892/ijo.2010.865
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发表时间：
2011-02
影响因子：
5.2
通讯作者：
H. Azuma;N. Ibuki;T. Inamoto;K. Koyama;Shinya Utimoto;Yutaka Fujisue;Y. Mizutani;H. Nomi;T. Ubai;Y. Katsuoka
中科院分区：
文献类型：
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作者：
H. Azuma;N. Ibuki;T. Inamoto;K. Koyama;Shinya Utimoto;Yutaka Fujisue;Y. Mizutani;H. Nomi;T. Ubai;Y. Katsuoka
在本研究中，我们报告了经直肠超声引导下腹腔镜根治性直肠癌切除术（LRP）的实用性，以及一种新的手术方法的效果“7个关键要素的手术技巧的早期恢复泌尿系统”（“7个关键要素”）。在2007年7月至2010年6月期间接受腹腔镜直肠癌切除术的170例患者中，72例患者在这7个关键要素的基础上进行了治疗（第1组），包括1）保留骨盆内筋膜，2）膀胱颈，3）骨盆神经，4）膜尿道，5）尿道括约肌和6）膀胱颈吊带悬吊固定器官定位，（7）Denonvilliers筋膜修复组（第2组）98例。我们比较了两组患者的术后恢复时间和术后病程。7个关键要素的应用导致显著更早的恢复。在第1组中，术后使用尿垫的数量在术后所有检查时间点（1、3、6和12个月）均显著减少（p<0.0001）。在第1组中，超过一半的患者（54%）在术后3个月内实现了排尿通畅，93%在术后6个月内实现，所有患者均在术后12个月内实现。然而，在第2组中，<10%的患者（8.5%，p<0.0001）在3个月内实现了再灌注，23%（P<0.0001）在6个月内实现了再灌注。因此，研究结果表明，经直肠超声引导下的7个关键操作技能要素可显著改善LRP的结局，缩短术后恢复所需的时间。
In the present study, we report the utility of transrectal ultrasonography guidance for laparoscopic radical prostatectomy (LRP), and the effect of a novel surgical approach of 'seven key elements of operative skill for the early recovery of urinary continence' ('7 key elements'). Among 170 patients who underwent laparoscopic prostatectomy between July 2007 and June 2010, 72 were treated on the basis of these 7 key elements (group 1), which included the preservation of 1) endopelvic fascia, 2) bladder neck, 3) pelvic nerve, 4) membranous urethra, 5) urethral sphincter and fixation of the organ positioning with 6) bladder neck sling suspension, and 7) restoration of the Denonvilliers' fascia, while the remaining 98 were not (group 2). We compared the data for the two groups with regards to the time taken for recovery of continence, and post-operative course. Application of the 7 key elements led to significantly earlier recovery of continence. In group 1, the number of urinary pads used after surgery was significantly reduced at all of the examined time-points after surgery (1, 3, 6 and 12 months) (p<0.0001). In group 1, more than half of the patients (54%) achieved urinary continence within 3 months, 93% achieved it within 6 months, and all patients had achieved it within 12 months after surgery. However, in group 2, <10% of the patients (8.5%, p<0.0001) achieved continence within 3 months, and 23% (P<0.0001) achieved it within 6 months. Therefore, the results show that the 7 key elements of operative skill with transrectal ultrasonography guidance significantly improve the outcome of LRP, reducing the time required for the recovery of continence.