發(fā)布時間：2018-07-01 20:17

  本文選題：前列腺癌 + 腹腔鏡��； 參考：《大連醫(yī)科大學》2014年碩士論文

【摘要】：目的：比較腹腔鏡前列腺癌根治術中不同的膀胱尿道吻合方式對術后吻合口并發(fā)癥的影響。 方法：2011年2月~2013年9月我科對66例臨床局限性前列腺癌實施腹腔鏡前列腺癌根治術，手術采用經腹腔入路�；颊吒鶕�(jù)吻合方式不同分為兩組，一組24例采用間斷縫合的膀胱尿道吻合方式，另一組42例采用連續(xù)縫合方式。比較兩種手術方法的手術時間、術后吻合口漏尿、拔管后吻合口狹窄及一個月、三個月、六個月的尿失禁情況的差異。 結果：66例腹腔鏡前列腺癌根治術均獲成功，無一例中轉開放手術。間斷縫合組：尿道膀胱吻合用時27~40min，平均35.7min；出現(xiàn)吻合口漏尿3例，分別于術后3~6天出現(xiàn)，漏尿2~4天后愈合；留置導尿2周拔除尿管后一個月，2例出現(xiàn)排尿困難，再次留置導尿一周后排尿好轉；術后一個月隨診15例控尿良好，9例出現(xiàn)尿失禁；三個月隨診19例控尿良好，5例出現(xiàn)尿失禁；六個月隨診21例控尿良好，3例出現(xiàn)尿失禁。連續(xù)縫合組：尿道膀胱吻合用時15~25min，平均20.5min；出現(xiàn)吻合口漏尿2例，分別于術后3天、5天出現(xiàn)，漏尿2天后愈合；留置導尿2周拔除尿管后一個月，1例出現(xiàn)排尿困難，再次留置導尿一周后排尿好轉；術后一個月隨診33例控尿良好，9例出現(xiàn)尿失禁；三個月隨診40例控尿良好，，2例出現(xiàn)尿失禁；六個月隨診41例均控尿良好，僅1例出現(xiàn)尿失禁。 結論：腹腔鏡前列腺癌根治術中采用連續(xù)縫合的膀胱尿道吻合方式較間斷縫合可縮短手術時間，降低吻合口漏尿、吻合口狹窄及尿失禁等并發(fā)癥的發(fā)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 .
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.25

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