本文選題：前列腺癌 + 前列腺切除術(shù)　； 參考：《蘇州大學(xué)》2014年碩士論文

【摘要】：目的尿失禁是根治性前列腺切除術(shù)后常見并發(fā)癥之一，也是影響患者術(shù)后生活質(zhì)量的重要因素，本課題目的在于評價根治性前列腺切除術(shù)后患者的尿控功能，同時從客觀臨床因素、手術(shù)技術(shù)、術(shù)后功能鍛煉等方面研究相關(guān)影響因素。 方法2007年6月至2013年6月，我院對術(shù)前TNM分期為T1c-T2c的153例前列腺癌患者進行根治性手術(shù)（恥骨后根治性前列腺切除術(shù)(RRP)55例、腹腔鏡根治性前列腺切除術(shù)(LRP)98例），回顧所有患者的臨床資料，隨訪術(shù)后尿控情況，評價尿控功能，采用單變量和多變量分析對可能影響因素進行統(tǒng)計分析。 結(jié)果153例手術(shù)均獲成功。術(shù)后4周、12周，RRP組和LRP組尿控率分別為12.7%（7/55）、69.1%（38/55）；17.3%（17/98）、74.5%（73/98）。12周以后，兩組手術(shù)尿控率基本持平，至術(shù)后48周，兩組尿控率分別為92.7%（51/55）和93.9%（92/98）。多因素分析結(jié)果顯示影響尿控恢復(fù)的主要因素有：患者手術(shù)時年齡（P=0.012）、既往經(jīng)尿道前列腺電切術(shù)（TURP）（P=0.005）、術(shù)前新輔助內(nèi)分泌治療（NHT）（P=0.022）、前列腺體積（P=0.039）和術(shù)中保留血管神經(jīng)束（NVB）（P=0.002）。 結(jié)論根治性前列腺切除術(shù)后絕大部分患者均能在48周內(nèi)恢復(fù)尿控，且恢復(fù)為漸進式，術(shù)后4-12周恢復(fù)速度最快，LRP后患者早期尿控恢復(fù)率較RRP高，而兩組手術(shù)遠(yuǎn)期具有相似的尿控效果。手術(shù)時年齡、既往TURP和術(shù)中保留NVB為影響術(shù)后尿控的獨立因素，術(shù)前NHT和前列腺體積的大小也對術(shù)后尿控恢復(fù)有影響。
[Abstract]:Objective urinary incontinence is one of the common complications after radical prostatectomy and an important factor affecting the quality of life after prostatectomy. At the same time, the related factors were studied from the aspects of objective clinical factors, surgical techniques, postoperative functional exercise and so on. Methods from June 2007 to June 2013, our hospital performed radical surgery (55 cases of posterior radical prostatectomy) with TNM staging as T1c-T2c. Laparoscopic radical prostatectomy (LRP) was performed in 98 patients. The clinical data of all patients were reviewed, the control status of urine was followed up, the function of urinary control was evaluated, and the possible influencing factors were analyzed by univariate and multivariate analysis. Results 153 cases were successfully operated. After 4 weeks and 12 weeks after operation, the urinary control rates of RRP group and LRP group were 12.775 / 55 / 69.1and 38 / 55 / 17.3 / 74.573 / 98 / 12 respectively. After 12 weeks of operation, the urinary control rate of the two groups was basically unchanged, and by 48 weeks after operation, the urinary control rates in the two groups were 92.775 / 555) and 93.992 / 98 / 993 / 98, respectively. The results of multivariate analysis showed that the main factors affecting the recovery of urinary control were: the age of the patient was 0.012 at the time of operation, the transurethral resection of the prostate (TURP) was performed, the neoadjuvant endocrine therapy before operation was NHTP 0.022, the prostate volume was 0.039) and the Vascular and nerve bundles were preserved during operation. Conclusion the majority of patients after radical prostatectomy can recover urinary control within 48 weeks, and the recovery rate of early urinary control is higher than that of RRP at 4-12 weeks after radical prostatectomy. The two groups had similar urinary control effect in long term. Age of operation, previous TURP and preservation of NVB during operation were independent factors affecting postoperative urinary control. Preoperative NHT and volume of prostate also affected the recovery of postoperative urinary control.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R699.8

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