关键词： 机器人前列腺癌根治术；膀胱颈保留术；最大尿道长度保留术；早期尿控；局限性前列腺癌
曲发军 ，张宗勤 ，吴震杰 ，王林辉 ，崔心刚
评估使用膀胱颈保留术（Bladder neck preservation，BNP）和最大尿道长度保留术（Maximal urethral length preservation，MULP）进行机器人辅助前列腺癌根治术（Robot-assisted radical prostatectomy，RARP）对 术后早期尿控恢复的治疗意义。方法：回顾性分析 2018~2019 年本中心施行机器人前列腺癌根治术的患者信息，纳 入标准为 Gleason 评分≤ 7（3+4）、≤ cT2c 分期以及 PSA<20ng/ml，排除在磁共振成像显示膀胱颈或前列腺尖部受 累的患者。共有 24 例患者接受联合保留最大尿道长度和膀胱颈的尿道重建术。尿控定义为不穿垫子或只穿一个安 全垫。结果：拔除导尿管后即刻（术后 2 周），以及术后 1 个月、3 个月和 6 个月的尿控率分别为 12（50.0%）、 18（75.0%）、20（83.3%）和 23（95.8%），2 例患者出现尿瘘（8.3%），未见手术切缘阳性病例。结论：对于 Gleason 评分≤ 7 的局限性前列腺癌患者，联合使用 BNP 和 MULP 的尿道重建技术可实现 RARP 术后尿控快速恢复。
To evaluate early recovery of urinary continence after robot-assisted radical prostatectomy (RARP) with urethral realignment using bladder neck preservation (BNP) and maximal urethral length preservation (MULP). Methods: Patients who underwent RARP between 2018 and 2019 owing to prostate cancer with a Gleason score<7 (3+4), ≤ cT2c stage, and prostate-specific antigen level<20ng/ml were investigated. Patients with tumors of the bladder neck or apex on magnetic resonance imaging were excluded. 24 patients in total underwent RARP with BNP and MULP urethral realignment. Continence was defined as wearing no pad (or one). Results: The continence rates were 12 (50%), 18 (75%), 20 (83.3%) and 23 (95.8%) respectively after Foley catheter removed at 2 weeks 1 month, 3 and 6 months after operation. 2 (8.3%) cases were found urine fistula and no positive surgical margin found. Conclusion: Urethral realignment under BNP and MULP can accelerate the continence recovery after RARP in young patients with localized prostate cancer and Gleason score ≤ 7.