机器人腹腔镜下前列腺癌根治术中保留性神经的技术改进及短期随访  

The improvement of techniques in nerve-sparing robotic radical prostatectomy and the short-term follow-up

作　　者：高旭[1] 王海峰[1] 杨波[1] 马春飞[1] 王辉清[1] 鲁欣[1] 王燕[1] 李耀明[1] 方梓宇 施振凯 施挺[1] 侯建国[1] 许传亮[1] 盛夏[1] 孙颖浩[1] 

机构地区：[1]长海医院泌尿外科,上海200433

出　　处：《中华腔镜泌尿外科杂志（电子版）》2015年第4期2-4,共3页Chinese Journal of Endourology(Electronic Edition)

基　　金：国家自然科学基金项目(81172076)

摘　　要：目的 通过分析长海医院机器人前列腺癌根治术的手术视频资料和患者术后的短期随访结果,总结机器人腹腔镜下前列腺癌根治术中保留性神经的技巧。方法 分析自2012年3月至2013年7月的80例在我院行机器人腹腔镜下前列腺癌根治术的手术视频资料（80例手术由4名术者分别完成）,筛选采用我中心建立的改良的“面纱”技术,即“头盔”技术的保留双侧性神经的手术9例,保留单侧性神经的手术5例,分析其手术技巧,并进行了短期性功能随访。结果 14例手术均为经腹膜途径顺利完成。手术时间为115-382 min,平均175 min;患者术中出血量50-1400 ml,平均145 ml,术中输血1例,术后2-4 d下床活动,14 d拔除导尿管。术后住院天数为6-19 d,平均9 d。术后4周血清PSA均〈0.01 ng/ml。术后3个月尿控有效率（以每天应用尿垫≤1块为标准）为92.9%（13/14）。术后3个月能恢复完整性过程的共5例（其标准为ESI或者SHIM〉17分）。保留双侧性神经的9例中有4例恢复,保留单侧性神经的5例中有1例恢复。结论 “头盔”技术能够保留更多的前列腺周围的筋膜,并尽量减少了耻骨前列腺韧带等尖部结构的破坏,从而有利于最大限度地恢复患者的尿控和勃起功能。Objective Through analyzing videoes of robot assisted radical prostatectomy and short-term potent follow up, reveal the tips of nerve sparing techniques during the robot assisted radical prostatectomy. Methods From March 2012 to July 2013, 80 patients who were performed robot assisted radical prostateetomy were involved in the present study. Among the 80 cases, we choose 14 cases including 9 cases which were performed bilateral nerve sparing surgery and 5 cases which were performed unilateral nerve sparing surgery. All the surgeries were performed with improved ＂veil＂ technique which we called ＂helmet＂ technique. Short-term potent follow up result was analyzed. Results All the 14 surgeries were successfully performed through intraperitoneal route, and no one was converted to open surgery. The average operation time was 175 （115-382） min, and mean blood loss was 145 （50-1400） ml. All the catheters were released 14 days after surgery. Postoperative hospital stay was 9 （6-19） days. The PSA was detected 4 weeks after surgery and none exceed 0.01ng/ml. 3 months after surgery, 92.9% （13/14） cases were achieved effective continence （less than one pad per day）. 3 months after surgery, with the assessment criteria of erection sufficient for intercourse （ESI）, there were 4 cases in 9 bilateral nerve sparing surgery and 1 case in 5 unilateral nerve sparing surgery were able to finish sexual intercourse. Conclusions The ＂helmet＂ technique can preserve more prostate fascia and avoid the destruction of the apex structure. Thus it can achieve a better potent and continence revovery.

关 键 词：机器人 腹腔镜 前列腺肿瘤 手术 随访 

分 类 号：R737.25[医药卫生—肿瘤]