根治的前立腺摘除術後の尿失禁に関する検討 : 前立腺尖部の処理・吻合法の改良

Abstract

著者らは根治的前立腺摘除術後の尿失禁における前立腺尖部の処理ならび吻合法を改良したので, これを従来法と比較検討した.対象は, 前立腺癌に根治的恥骨後式前立腺摘除術を施行した36例で, うち24例(平均67.6歳)は従来法, 12例(平均64.8歳)は改良法を用いた.両群間で手術時間, 出血量に有意差は認めず, 尖部断端陽性率では差を認めなかった.術後尿失禁の消失率は出血量(1500cc未満と以上), 年齢(65歳未満と以上)では差は認めず, 従来法と改良法ではそれぞれ術後1ヵ月で8.3%, 41.7%, 3ヵ月で25.0%, 91.7%, 6ヵ月で29.2%, 100%, 12ヵ月で58.3%, 100%と改良法で有意に早期消失を認めた.術後合併症は従来法で創し開が4例, 膀胱尿道吻合部結石が1例あり, 改良法では術後血腫が1例, 一時的排尿障害が1例を認めたが, 吻合部狭窄は両群ともに認めなかった.以上, 本改良法は術後の尿失禁を軽減する有効な方法と考えられた

Urinary incontinence impairs the quality of life for patients following radical prostatectomy. We retrospectively reviewed the records of 36 patients who underwent radical retropubic prostatectomy between 1987 and 2002, and achieved the time from operation until urinary continence. A modification in the technique of apical dissection was introduced in 1999 and applied in 12 cases of consecutive radical prostatectomy. The principles for this technique were based on sharp division of the dorsal vein complex, continuous suturing cut edges of lateral pelvic fascia, and anterior anastomotic sutures including lateral pelvic fascia as well as urethra and bladder neck. None of the patients undergoing the new technique used pads at 6 months. With introduction of this technique, the rate of continence at 12 months increased from 58.3 to 100.0%. Our results suggest that the surgical technique of apical dissection is an important factor associated with postprostatectomy in continence.