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目的介绍单针双向牵引连续缝合技术在腹腔镜下根治性前列腺切除术(LRP)中的应用。方法回顾性分析2012年1月至2014年11月42例经腹膜外途径LRP的临床资料。术中采用单针双向牵引连续缝合技术行膀胱尿道吻合。缝合过程中缝合线尾置于体外保持适当张力,从膀胱颈口3点钟处“外进内出”、对应尿道“内进外出”顺时针方向连续缝合,缝合完毕后剪去缝针及多余线尾,充分双向牵引拉紧线头及线尾后打结。记录LRP总手术时间及膀胱尿道吻合时间、引流管及导尿管留置时间,观察并发症以及手术切缘阳性率等指标。结果 42例手术均获得成功,术后随访时间2~35(15.2±5.6)个月,因抑郁症术后8月自杀死亡1例,其余患者均存活。LRP总手术时间为105~265(160.5±52.4)min,膀胱尿道吻合时间为11~27(15.8±4.5)min。膀胱尿道吻合口短暂漏尿3例(6.98%),在随访期间内未发现膀胱尿道吻合口狭窄。切缘阳性6例(13.95%),暂时性尿失禁17例(39.5%),真性尿失禁1例(2.32%)。结论在LRP中,单针双向牵引连续缝合技术能够在有效保证膀胱尿道吻合质量、不增加并发症发生率的前提下,进一步简化吻合操作步骤、缩短手术时间,对于LRP的推广和普及具有较大促进作用。
Objective To introduce the application of single needle bi-directional traction suture technique in laparoscopic radical prostatectomy (LRP). Methods The clinical data of 42 patients with LRP treated by the extraperitoneal route from January 2012 to November 2014 were retrospectively analyzed. Intraoperative use of single-needle two-way traction continuous suture line of bladder and urethra anastomosis. Stitching process suture tail placed in vitro to maintain proper tension from the bladder neck mouth at 3 o’clock “outside into the inside ”, corresponding to the urethra “inward and outward ” clockwise direction of continuous suture, cut off after suture Stitches and extra thread tail, full two-way traction tighten the thread head and tail knotted. Record LRP total operation time and bladder and urethra anastomosis time, drainage tube and catheter retention time, observe the complications and surgical margin positive rate and other indicators. Results All the 42 cases were successful. The follow-up time ranged from 2 to 35 (15.2 ± 5.6) months. One patient died of suicide in August after operation and the rest survived. The total operative time of LRP was 105-265 (160.5 ± 52.4) min, and the duration of bladder and urethra anastomosis was 11-27 (15.8 ± 4.5) min. Bladder and urethra anastomosis transient leakage of urine in 3 cases (6.98%), during the follow-up period did not find bladder and urethra anastomotic stenosis. Positive margins in 6 cases (13.95%), temporary urinary incontinence in 17 cases (39.5%), true incontinence in 1 case (2.32%). Conclusions In LRP, the single needle bi-directional traction continuous suture technique can further simplify the procedure of anastomosis and shorten the operation time under the premise of effectively ensuring the anastomosis of the bladder and urethra without increasing the incidence of complications, which has a greater effect on the promotion and popularization of LRP enhancement.