| 摘要: |
| 目的 探讨机器人辅助腹腔镜下前列腺癌根治术后盆底肌锻炼（PFMT）模式如何影响术后尿失禁康复。方法 回顾性分析2013年6月至2018年6月我科单术者完成的186例机器人辅助腹腔镜下前列腺癌根治术患者的临床及随访资料。将患者分为快速康复（每天使用尿垫数≤ 1块且康复时间≤ 3个月）、缓慢康复（每天使用尿垫数≤ 1块但康复时间>3个月）和尿失禁（每天使用尿垫数>1块）3组。比较3组患者临床资料及快速康复组和缓慢康复组患者PFMT模式的差异，采用多因素二元logistic回归模型分析术后尿失禁快速康复的影响因素。结果 60例患者失访，共126例完成随访纳入研究。快速康复组66例，缓慢康复组26例，尿失禁组34例，患者诊断年龄分别为（62.7±6.8）岁、（67.0±7.5）岁、（70.3±7.0）岁，差异有统计学意义（P<0.01）；接受性神经保留的患者比例分别为57.6%（38/66）、26.9%（7/26）、17.6%（6/34），差异有统计学意义（P=0.011）。92例术后尿失禁康复患者中，8例术后拔除尿管即刻尿失禁即康复，其余84例术后进行PFMT，其中快速康复组58例，缓慢康复组26例。快速康复组坚持每天进行PFMT、选择在白天进行PFMT的患者比例均高于缓慢康复组[70.7%（41/58）vs 38.5%（10/26）、69.0%（40/58）vs 23.1%（6/26）]，差异均有统计学意义（P均<0.05）。多因素二元logistic回归分析显示，患者诊断年龄（OR=1.09，P=0.044）、术中不保留性神经（OR=2.73，P=0.034）、术后不坚持PFMT（OR=6.30，P=0.034）和主要PFMT时间段不在白天（OR=6.76，P=0.006）是术后尿失禁快速康复的危险因素。结论 PFMT是机器人辅助腹腔镜下前列腺癌根治术后尿失禁康复（尤其是快速康复）的重要方法，患者年龄、是否保留性神经、是否坚持PFMT和PFMT主要时间段与术后早期尿失禁快速康复相关。 |
| 关键词: 盆底肌锻炼 机器人辅助腹腔镜下根治性前列腺切除术 尿失禁 康复 |
| DOI：10.16781/j.0258-879x.2020.11.1284 |
| 投稿时间：2020-03-10修订日期：2020-06-22 |
| 基金项目:上海市科学技术委员会科研计划项目（18441903200）. |
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| Effect of pelvic floor muscle training mode on recovery of urinary continence after robot-assisted laparoscopic radical prostatectomy |
| QU Min,JIA Ze-peng,LIAN Bi-jun,ZHU Feng,CHEN Huan,WANG Yan,GAO Xu* |
(Department of Urology, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To explore the effect of pelvic floor muscle training (PFMT) mode on the recovery of postoperative urinary continence after robot-assisted laparoscopic radical prostatectomy. Methods The clinical and followup data of 186 patients receiving robot-assisted laparoscopic radical prostatectomy by a single surgeon were retrospectively collected from Jun. 2013 to Jun. 2018. The patients were divided into three groups:rapid recovery group (≤ 1 pad, recovery time ≤ 3 months), slow recovery group (≤ 1 pad, recovery time >3 months) and urinary incontinence group (>1 pad). The clinical data of the three groups and the difference of PFMT mode were compared between the rapid and slow recovery groups. The influencing factors of rapid recovery of postoperative urinary incontinence were analyzed by multivariate binary logistic regression model. Results Sixty patients were lost during follow-up, hence 126 patients were finally followed-up and included in this study. Sixty-six patients in the rapid recovery group, 26 in the slow recovery group and 34 in the urinary incontinence group were diagnosed at the age of (62.7±6.8), (67.0±7.5) and (70.3±7.0) years, respectively (P<0.01). Meanwhile, the proportions of nerve sparing in the three groups were significantly different among the three groups (57.6%[38/66], 26.9%[7/26]and 17.6%[6/34], P=0.011). Among the 92 patients with urinary incontinence rehabilitation, eight patients recovered immediately after removing the catheter, and the remaining 84 patients underwent PFMT after operation, including 58 cases in the rapid recovery group and 26 cases in the slow recovery group. The proportions of patients who insisted on daily PFMT and chose to do PFMT in the daytime in the rapid recovery group were significantly higher than those in the slow recovery group (70.7%[41/58]vs 38.5%[10/26]and 69.0%[40/58]vs 23.1%[6/26], both P<0.05). Multivariate binary logistic regression analysis showed that age of diagnosis (OR=1.09, P=0.044), non-nerve sparing (OR=2.73, P=0.034), failure to continue PFMT after operation (OR=6.30, P=0.034) and absence of PFMT in the daytime (OR=6.76, P=0.006) were the risk factors for rapid recovery of urinary incontinence after operation. Conclusion PFMT is important to urinary continence after robot-assisted laparoscopic radical prostatectomy, especially for rapid recovery. Patients' age, nerve sparing or not, keeping PFMT and PFMT time are associated with the rapid recovery of early postoperative urinary incontinence. |
| Key words: pelvic floor muscle training robot-assisted laparoscopic radical prostatectomy urinary incontinence rehabilitation |
