【摘要】 【目的】观察温针灸治疗腹腔镜下前列腺癌根治术后肾气不固型尿失禁的临床疗效。【方法】选取2020年1月至2024年12月南京中医药大学附属医院（江苏省中医院）病房及门诊收治的100例明确诊断为腹腔镜下前列腺癌根治术后尿失禁的患者为研究对象。按随机数字表将患者随机分为观察组和对照组，每组各50例。对照组给予常规盆底肌训练治疗，观察组在对照组的基础上，给予温针灸治疗。连续治疗12周。治疗12周后，评价2组临床疗效。观察2组患者治疗前后国际尿失禁咨询委员会问卷量表（ICI-Q-SF）评分、尿失禁生活质量问卷（I-QOL）评分与中医证候积分的变化情况，以及最大尿流率（Qmax）、治疗后膀胱顺应性、膀胱最大容量与初尿意时膀胱容量的情况。比较2组患者治疗前后尿神经生长因子（NGF）/尿肌酐（UCr）的变化情况。【结果】（1）观察组总有效率为94.00%(47/50)，对照组为76.00%(38/50)。观察组疗效优于对照组，差异有统计学意义（P<0.05）。（2）治疗后，2组患者的各项中医证候评分均明显改善（P<0.05），且观察组在改善各项中医证候评分方面明显优于对照组，差异有统计学意义（P<0.05）。（3）治疗后，2组患者的ICIQ-SF评分及I-QOL评分均明显改善（P<0.05），且观察组在改善ICIQ-SF评分及I-QOL评分方面明显优于对照组，差异有统计学意义（P<0.05）。（4）治疗后，观察组患者的最大膀胱容量、初次排尿时膀胱容量以及膀胱顺应性明显均明显优于对照组，差异有统计学意义（P<0.05）。（5）治疗后，2组患者的NGF/Ucr和Qmax均明显改善（P<0.05），且观察组在改善NGF/Ucr和Qmax方面明显优于对照组，差异有统计学意义（P<0.05）。【结论】温针灸治疗腹腔镜下前列腺癌根治术后肾气不固型尿失禁，能够明显改善患者的漏尿症状，加速前列腺癌术后尿失禁症状的康复，显著改善患者的膀胱功能，提高患者术后尿流率，降低尿液中NGF的表达，从而提高患者的生活质量，疗效显著。更多还原

【Abstract】 Objective To observe the clinical efficacy of warm needling moxibustion in treating urinary incontinence of the kidney qi instability type following laparoscopic radical prostatectomy. Methods One hundred patients diagnosed with urinary incontinence after laparoscopic radical prostatectomy,admitted to the wards and outpatient clinics of the Affiliated Hospital of Nanjing University of Chinese Medicine(Jiangsu Province Hospital of Chinese Medicine) between January 2020 and December 2024,were selected as the study subjects. Patients were randomly divided into an observation group and a control group using a random number table,with 50 cases in each group. The control group received conventional pelvic floor muscle training therapy, while the observation group received warm needling moxibustion in addition to the same training as the control group. The treatment course lasted for 12 consecutive weeks. Twelve weeks after treatment, the clinical efficacy of both groups was evaluated. Changes in the International Consultation on Incontinence Questionnaire-Short Form(ICI-Q-SF) score,the Incontinence Quality of Life(I-QOL) questionnaire score,and traditional Chinese medicine(TCM) syndrome scores were observed before and after treatment in both groups. Additionally,maximum urinary flow rate(Qmax),post-treatment bladder compliance, maximum bladder capacity, and bladder capacity at first sensation of urination were assessed. Changes in urinary nerve growth factor(NGF)/urinary creatinine(UCr) ratio were compared before and after treatment between the two groups. Results(1) The total effective rate was 94.00%(47/50) in the observation group and 76.00%(38/50) in the control group. The efficacy of the observation group was superior to that of the control group, and the difference was statistically significant(P<0.05).(2) After treatment,all TCM syndrome scores were significantly improved in both groups(P<0.05),and the improvement was significantly greater in the observation group than the control group,with a statistically significant difference(P<0.05).(3) After treatment,both the ICIQ-SF and I-QOL scores were significantly improved in both groups(P<0.05),and the improvement was significantly greater in the observation group than the control group,with a statistically significant difference(P<0.05).(4) After treatment, the maximum bladder capacity, bladder capacity at first sensation of urination,and bladder compliance were significantly better in the observation group than in the control group,with statistically significant differences(P<0.05).(5) After treatment,both the NGF/Ucr ratio and Qmax were significantly improved in both groups(P<0.05),and the improvement was significantly greater in the observation group than the control group, with a statistically significant difference(P<0.05). Conclusion Warm needling moxibustion in treating urinary incontinence of the kidney qi instability type after laparoscopic radical prostatectomy can significantly alleviate patients’ urinary leakage symptoms,accelerate the recovery of post-operative incontinence,markedly improve bladder function,increase post-operative urinary flow rate, reduce the expression of NGF in urine, and thereby enhance patients’ quality of life, demonstrating significant therapeutic efficacy.更多还原