保留Retzius间隙的前入路机器人辅助腹腔镜根治性前列腺切除术的疗效分析  

Curative effects of Retzius sparing robotic assisted laparoscopic radical prostatectomy through anterior path

作　　者：王帅[1] 周密[1] 祁小龙[1] 刘锋[1] 张琦[1] 郑玮 张大宏[1] Wang Shuai; Zhou Mi; Qi Xiaolong; Liu Feng; Zhang Qi; Zheng Wei; Zhang Dahong(Department of Urology, Zhejiang Provincial People＇s Hospital, People＇s Hospital of Hangzhou Medical College, Hangzhou 310014, China)

机构地区：[1]浙江省人民医院杭州医学院附属人民医院泌尿外科,杭州310004

出　　处：《中华泌尿外科杂志》2018年第10期727-732,共6页Chinese Journal of Urology

基　　金：浙江省医药卫生科技项目（2016KYB009,2018KY263）

摘　　要：目的探讨应用保留Retzius间隙的前入路机器人辅助腹腔镜根治性前列腺切除术（RARP）的治疗效果。 方法回顾性分析2015年7月至2017年7月收治的150例前列腺癌患者的临床资料，根据手术方式分为2组，其中75例行保留Retzius间隙的前入路RARP，为Rs-RARP组；75例行传统前入路RARP，为CA-RARP组。Rs-RARP组年龄（68.6±5.3）岁；前列腺体积中位值38.9 ml （20.6～60.1 ml） ；术前PSA（15.7±3.3）ng/ml；体重指数（25.2±3.6）kg/m2；术前Gleason评分3＋3分24例，3＋4分28例，4＋3分23例；临床分期T1c期11例，T2a～T2b期59例，T2c期5例。CA-RARP组年龄（69.6±5.6）岁；前列腺体积中位值38.3 ml （18.4～59.8 ml）；术前PSA（17.6±4.4）ng/ml；体重指数（27.5±2.7）kg/m2；术前Gleason评分3＋3分29例，3＋4分26例，4＋3分20例；临床分期T1c期17例，T2a～T2b期51例，T2c期7例。比较两组手术时间、术中出血量、围手术期输血率、拔尿管后24 h及术后1、3、6、12个月控尿恢复情况，以及勃起功能恢复情况、术后肿瘤控制情况等。 结果两组手术均顺利完成，无中转开放或普通腹腔镜手术，无严重术中、术后并发症。Rs-RARP组和CA-RARP组手术时间分别为（125.3±15.6）min和（108.4±21.7）min，差异无统计学意义（P〉0.05）。Rs-RARP组术中出血量多于CA-RARP组[（106.1±10.3）ml与（82.2±18.4）ml，P〈0.05]，而围手术期输血例数[2例（2.7%）与1例（1.3%）]差异无统计学意义（P〉0.05）。Rs-RARP组与CA-RARP组术后排气时间[（1.5±0.6）d与（1.5±0.4）d]、恢复进食时间[（2.0±0.5）d与（2.0±0.6）d]、术后住院时间[（8.0±1.2）d与（9.0±1.8）d]、住院总费用[（5.8±1.3）万元与（6.0±1.6）万元]和术后并发症[5例（6.7%）与3例（4.0%）]的差异均无统计学意义（P〉0.05）。Rs-RARP组pT1c期18例，pT2a～pT2b期52例，pT2c期5例；CA-RARP组pT1c期12例，pT2a～pT2b期56例，pT2c�ObjectiveTo investigate the curative effects of Retzius sparing robotic assisted laparoscopic radical prostatectomy（RARP） through anterior path. MethodsFrom July 2015 to July 2017, 75 patients undergoing Retzius sparing RARP（Rs-RARP group） and 75 patients undergoing conventional anterior approach RARP（CA-RARP group） were retrospectively reviewed.Preoperative data of patients was collected as follows： age of （68.6±5.3） years, median prostate volume of 38.9 （20.6-60.1）m1, tPSA of （15.7±3.3）ng/ml, BMI of （25.2±3.6）kg/m2, biopsy Gleason score of 3＋ 3 in 24 cases, 3＋ 4 in 28 cases, 4＋ 3 in 23 cases, cTMN T1c in 11 cases, T2a-T2b in 59 cases, T2c in 5 cases, in Rs-RARP group; age of （69.6±5.6） years, median prostate volume of 38.3（18.4-59.8）ml, tPSA of （17.6±4.4） ng/ml, BMI of （27.5±2.7） kg/m2, biopsy Gleason score of 3＋ 3 in 29 cases, 3＋ 4 in 26 cases, 4＋ 3 in 20 cases, cTMN T1c in 17 cases, T2a-T2b in 51 cases, T2c in 7 cases, in CA-RARP group. The clinical data of the two groups, including operation time（OT）, intraoperative blood loss, perioperative blood transfusion rate, 24h/1m/3m/6m/12m continence situation and erectile function recovery, and postoperative oncological results were analyzed statistically. ResultsAll cases were successfully performed robotically without conversion or major intraoperative or postoperative complications. For operative time, Rs-RARP group was （125.3±15.6）mins and CA-RARP group was （108.4±21.7） mins, and the difference was not statistically significant （P〉0.05）. For estimated blood loss （EBL）, Rs-RARP group was （106.1±10.3）ml, with perioperative blood transfusion in 2 cases（2.67%）, and CA-RARP group was （82.2±18.4）ml, with perioperative blood transfusion in 1 cases（1.33%）. The Rs-RARP group had more EBL than the CA-RARP group（P〈0.05）. No difference was found in perioperative blood transfusion rate（P〉0.05）. The postoperative oral intake time was （1.5±0.6） d, p

关 键 词：前列腺肿瘤 机器人 腹腔镜手术 保留Retzius间隙 根治性前列腺切除术 

分 类 号：R737.25[医药卫生—肿瘤]