机器人辅助腹腔镜术治疗高危前列腺癌的临床经验  

Experience of robot-assisted laparoscopic radical prostatectomy for high risk prostate cancer

作　　者：袁建林[1] 孟平[1] 杨晓剑[1] 王延柱[1] 秦卫军[1] 张运涛[1] 张龙龙[1] 武鹏[1] 田春娟[1] 袁稼芮 

机构地区：[1]第四军医大学西京医院泌尿外科,西安710032 [2]美国华盛顿大学生化学院

出　　处：《临床泌尿外科杂志》2016年第1期15-18,共4页Journal of Clinical Urology

摘　　要：目的：探讨机器人辅助腹腔镜根治性前列腺切除术（RALRP）在治疗高危前列腺癌中的价值,总结其临床经验。方法：回顾性分析2013年2月-2015年10月采用RALRP治疗86例高危前列腺癌患者的临床资料：平均年龄（67.3±10.5）岁。术前检查单独PSA〉20ng/ml者19例,单独Gleason评分≥8分9例,PSA〉20ng/ml并Gleason评分≥8分者58例;术前诊断为T_3期者9例。手术方式均采用经腹膜内路径机器人辅助腹腔镜根治性前列腺切除术,同时行盆腔淋巴结清扫。结果：本组均顺利完成机器人手术,无中转开放手术者。平均手术时间（146±45）min,平均出血量（95±53）ml,术后住院时间为（7.3±2.5）d。术后6例拔管后出现尿失禁,于1周-3个月恢复控尿;术后3例漏尿,2例淋巴漏。术后病理检查显示淋巴结阳性7例;切缘阳性4例,术后控尿恢复后给予局部放射治疗。结论：对于高危前列腺癌患者,采用以RALRP为核心的综合治疗策略是安全有效的。Objective：To evaluate the clinical efficiency of robot-assisted laparoscopic radical prostatectomy（RALRP）for high risk prostate cancer and summarize the clinical experience.Method：The clinical data of 86 patients with high risk prostate cancer who underwent RALRP from February 2013 to October 2015 were analyzed retrospectively.The patients＇ average age was（67.3±10.5）years old.In preoperative examination,there were19 cases with initial PSA〉20ng/ml only,9cases biopsy Gleason score≥8only and 58 cases with initial PSA〉20ng/ml and Gleason score≥8.Meanwhile,nine cases were diagnosed T3 phase clinical staging preoperatively.All patients underwent intraperitoneal RALRP and pelvic lymph node dissection.Result：All RALRP procedures were successfully performed with da Vinci robotic system and there was no open conversion.The mean operation duration was（146±45）min,mean blood loss was（95±53）ml,and mean postoperative hospital stay was（7.3±2.5）d.Postoperative temporary urinary continence occurred in six cases,and all of them recovered in one week to three months.Three cases of urine leak and two cases of lymphatic leak occurred after RALRP.Postoperative pathology indicated that seven cases were found positive lymph nodes,and four cases were found positive surgical margins.So for these 11 patients local-regional radiotherapy became necessary after urinary continence was controlled.Conclusion：As the core of comprehensive treatment strategies,RALRP is safe and effective for high risk prostate cancer.

关 键 词：前列腺癌 机器人辅助腹腔镜根治性前列腺切除术 前列腺切除术 

分 类 号：R737.25[医药卫生—肿瘤]