机器人辅助腹腔镜前列腺癌根治术改良方法的近期疗效分析  

Analysis of the short-term efficacy of modified robot-assisted laparoscopic radical prostatectomy

作　　者：王东[1] 刘竞[1] 任尚青 周放 李波[1] 杨文钊 吕倩 李安 聂钰 田景芝[1] WANG Dong;LIU Jing;REN Shangqing;ZHOU Fang;LI Bo;YANG Wenzhao;LV Qian;LI An;NIE Yu;TIAN Jingzhi(Robotic Minimally Invasive Surgery Center, Sichuan Provincial People＇s Hospital, Chengdu, 610072, China)

机构地区：[1]四川省人民医院机器人微创中心,成都610072

出　　处：《临床泌尿外科杂志》2018年第6期432-434,438,共4页Journal of Clinical Urology

摘　　要：目的:阐述机器人辅助腹腔镜前列腺癌根治术(RARP)改良方法的手术技巧,探讨其临床应用价值。方法:回顾性分析我院机器人微创中心2017年3月~2018年2月行RARP的94例前列腺癌患者的临床资料,总结其手术技巧。改良要点:(1)经腹途径后入路,首先建立Denonvillier间隙,并留置纱条作为标记;(2)游离并显露背深静脉复合体,保留耻骨前列腺韧带;(3)T型切开膀胱颈前壁,辨别双侧输尿管口及前列腺交界处,沿前列腺包膜剥离膀胱颈,切开后唇,同标记纱布汇合;(4)切断双侧前列腺侧韧带,改良法悬吊缝扎阴茎背深复合体,于复合体侧方予以结扎;(5)简易重建盆底筋膜,连续双向膀胱尿道吻合。结果:手术均获成功,无中转开放病例。手术时间70~150min,平均(90±20)min;术中出血60~150ml,平均(120±30)ml;保留尿管时间4~7d,平均(5±1)d;术后住院6~9d,平均(8±1)d。无相关并发症发生。随访2~14个月,5例患者可即时尿控,术后1个月20例患者尿控恢复,术后3个月46例患者尿控恢复。结论:通过RARP的技术优化,能有效降低手术难度,缩短手术时间及学习曲线,提高手术效率,减少手术相关并发症的发生,值得推广。Objective：To discuss the modified surgical techniques of robot-assisted laparoscopic radical prostatectomy（RARP）and to explore its clinical value.Method：The clinical data of 94 patients with prostate cancer were analyzed retrospectively from March 2017 to February 2018 in Sichuan Provincial People＇s Hospital minimally invasive robotics center,and the surgical skills were summarized.The key points for the modified procedures of the operation include：（1）The Denonvillier space was first established through the abdominal approach,and the yarn was set up as a marker.（2）The dorsal vein complex was free and exposed,and the prostatic ligament was retained.（3）T incision of the anterior wall of the bladder neck and the intersection of the bilateral ureteral orifice and the prostate,and the bladder neck dissection was along the prostatic membrane.Incision of the posterior lip and meeting with marked gauze.（4）Cutting off bilateral prostatic ligaments and ligating the dorsal vein complex of the penis to ligation in the side of the complex.（5）Simple reconstruction of pelvic floor fascia and continuous bidirectional vesical urethra anastomosis.Result：All cases were successfully completed without conversion to open operation.The operation time was 70-150min,averaging（90±20）min;intraoperative bleeding was 60-150ml,averaging（120±30）ml;the urinary catheter was removed after surgery 4-7d,averaging（5±1）d;postoperative hospitalization 6-9d,averaging（8±1）d.No related complications occurred.During the follow-up period of 2-14 months,5 patients can immediately control urine,the urinary control of 20 patients were recovery in one month and 46 patients were recovered with 3 months.Conclusion：The technical optimization of RARP operation can effectively shorten the operation time and learning curve,improve the operative efficiency and reduce the occurrence of related operative complications,so it＇s worth popularizing.

关 键 词：机器人 腹腔镜 前列腺癌根治 改良 技巧 

分 类 号：R737.25[医药卫生—肿瘤]