经腹膜外途径与经腹途径机器人辅助腹腔镜下根治性前列腺切除术的比较分析  

Comparison of robot assistant radical prostatectomy by transperitoneal versus extraperitoneal approach

作　　者：夏丹[1] 王平[1] 秦杰[1] 景泰乐[1] 叶孙益[1] 汪朔[1] 

机构地区：[1]浙江大学附属第一医院泌尿外科,310000

出　　处：《中华泌尿外科杂志》2016年第3期165-168,共4页Chinese Journal of Urology

摘　　要：目的 比较经腹膜外途径与经腹途径机器人辅助腹腔镜下根治性前列腺切除术的疗效及安全性.方法 回顾性分析2014年9月至2015年4月165例行机器人辅助腹腔镜下根治性前列腺切除术患者的临床资料,按照时间顺序,早期79例行采用经腹途径,平均年龄（66.9±6.2）岁,平均体质指数（23.4±2.9） kg/m2,前列腺重量（33.8±16.7）g;后期86例采用经腹膜外途径,平均年龄（66.9±6.2）岁,平均体质指数（24.2±2.5）kg/m2,前列腺重量（36.5±20.7）g,差异均无统计学意义（P＞0.05）.两组术前PSA值和Gleason评分比较差异均无统计学意义（P＞0.05）.结果 两组手术均顺利完成,无中转开放或改行其他术式.经腹组和经腹膜外组的总体手术时间分别为（218.1±54.4）min和（180.2±47.1）min,差异有统计学意义（P＜0.05）.经腹膜外组和经腹组的装机时间分别为（21.5±7.1）min和（19.5±5.7） min,差异有统计学意义（P＜0.05）.经腹组和经腹膜外组的术中失血量分别为（122.4±71.O）ml和（140.4±90.7）ml,差异有统计学意义（P＜0.05）.两组的术后排气时间、术后肠道恢复排便时间、术后引流管留置时间、留置导尿时间、术后下床活动时间比较差异均无统计学意义（P＞0.05）.经腹组和经腹膜外组发生淋巴漏患者分别为19例（24.1％）和4例（4.7％）,差异有统计学意义（P＜0.05）.经腹组发生1例肠系膜扭转和1例吻合口迟发性出血.两组的手术切缘阳性率、术后3个月内无生化复发率、拔除导尿管即刻控尿率和术后3个月控尿率比较差异均无统计学意义（P＞0.05）.结论 与经腹途径比较,经腹膜外途径机器人辅助腹腔镜下根治性前列腺切除术在近期肿瘤控制情况和术后控尿功能恢复方面相似,但手术时间更短,术后并发症更少.Objective To compare the safety and oncological results of robot-assisted laparoscopic radical prostatectomy performed between transperitoneal and extraperitoneal approach.Methods 79 patients underwent transperitoneal robot-assisted laparoscopic radical prostatectomy （Tp-RLRP）.The other 86 consecutive patients went through extraperitoneal robot-assisted laparoscopic radical prostatectomy （Ep-RLRP）.Results All procedures were performed successfully without conversion.Total procedure time for Ep-RLRP was shorter than it for Tp-RLRP[（218.1 ± 54.4） min vs.（180.2 ± 47.1） min,P 〈 0.001].Docking time for Ep-RLRP was longer than Tp-RLRP [（21.5 ± 7.1） min vs.（19.5 ± 5.7） min,P 〈 0.001] Blood lost of Tp-RLRP was lesser than Ep-RLRP[（122.4 ± 71.0） ml vs.（140.4 ± 90.7） ml,P 〈 0.05].There were no significant differences between two groups in terms of bowel function recovery,drainage tube reserve,foley catheter duration,etc.There were 19 patients （24.1%）and 4 patients （4.7%）were suffered lymph leakage in two groups separately,P 〈 0.001.One delayed vesiclurethra hemorrhagic patient and one mesenteric torsion patient were happened in Tp-RLRP group.There were no significant differences between two groups in terms of surgical margin,biochemical recurrence and urine continence.Conclusion Compared to Tp-RLRP,Ep-RLRP can provide similar short-term oncological control,recovery of postoperative urine continence,shorter operation time and lower complication rates.

关 键 词：机器人 前列腺癌 根治性前列腺切除术 

分 类 号：TP242[自动化与计算机技术—检测技术与自动化装置] R737.25[自动化与计算机技术—控制科学与工程]