机器人辅助前列腺癌根治术和传统腹腔镜前列腺癌根治术两种手术方式的疗效比较  

A comparison of robotic-assisted laparoscopic radical prostatectomy versus traditional laparoscopic prostatectomy in the treatment of prostate cancer

作　　者：王建强 吴大鹏[1] 杨志尚[1] 宋文斌[1] WANG Jian-qiang,WU Da-peng,YANG Zhi-shang,SONG Wen-bin(Department of Urology,The First Affiliated Hospital of Xi＇an Jiaotong University,Xi＇an 710061 ,China)

机构地区：[1]西安交通大学第一附属医院泌尿外科,陕西西安710061

出　　处：《现代泌尿外科杂志》2018年第11期830-833,851,共5页Journal of Modern Urology

基　　金：国家自然科学基金(No.81672539)

摘　　要：目的回顾性分析机器人辅助腹腔镜前列腺癌根治术(RALRP)与传统腹腔镜前列腺癌根治术(LRP)两种手术方式的临床疗效,探讨机器人辅助腹腔镜在治疗前列腺癌中的应用价值。方法将2014年6月至2017年11月收集的229例前列腺癌患者分为两组,RALRP组159例,LRP组70例。分析比较两组的流行病学特点、手术时间、膀胱颈-尿道吻合时间、术中出血、肿瘤切缘阳性率、引流管拔除时间、留置尿管时间、术后住院时间、手术花费及术后尿控等方面的差异。结果 RALRP组与LRP组相比,在手术时间[(145.30±56.94)min vs.(234.13±89.8)min]、膀胱颈-尿道吻合时间[(13.61±3.05)vs.(26.71±5.38)min)]、术中出血[(102.47±71.93)mL vs.(236.4±171.25)mL)]、术后留置尿管时间[(17.47±3.14)d vs.(19.63±3.62)d]、术后住院时间[(7.13±2.88)d vs.(8.83±3.4)d]等方面均具有明显优势(P<0.001);在T1～T2期肿瘤中的术后肿瘤切缘阳性率及术后6月的尿失禁发生率(8.73%vs.19.30%)中,RALRP组也优于LRP组(P<0.05)。但在手术花费方面RALRP组则高于LRP组[(66152.81±8124.47)元vs.(44529.48±7614.29)元,P<0.001)]。结论与传统腹腔镜前列腺癌根治术相比,机器人辅助腹腔镜治疗前列腺癌在术中操作及术后恢复等方面均优于腹腔镜组;但机器人高昂的手术使用费可能限制了部分患者的使用。Objective To analyze the clinical efficacy of robotic-assisted laparoscopic radical prostatectomy （RALRP）and traditional laparoscopic radical prostatectomy （LRP）in the treatment of prostate cancer, and to explore the application of RALRP. Methods A total of 229 patients with prostate cancer treated during June 2014 and Nov. 2017 were divided into the RALRP group （n=159） and LRP group （n=70）. The epidemiological characteristics, operation time, bladder neck-urethral anastomosis time,intraoperative bleeding, positive rate of tumor margin,drainage tube removal time, catheter indwelling time, postoperative hospitalization time,operation costs, and postoperative urinary control were compared between the two groups. Results In the RALRP group and LRP group,the operation time was （145.30±56.94 vs.234.13±89.8）rain,bladder neck-urethral anastomosis time （13.61±3.05 vs. 26.71±5.38）min,intraoperative bleeding （102.47±71.93 vs. 236.4±171.25）mL, catheter indwelling time （17.47±3.14 vs.19.63±3.62）d and postoperative hospitalization time （7.13±2.88 vs. 8.83±3.4 d）, （all P±0. 001）. The RALRP group was also advantageous over the LRP group in the positive rate of tumor margin in T1-T2 tumors,and the incidence of urinary incontinence 6 months after operation （8.73% vs.19.30%）,（P〈0.05）.But in terms of operation costs, the LRP group was lower than the RALRP group （66152.81±8 124.47 vs.44529.48±7614.29）,（P〈0. 001）. Conclusion RALRP has advantages over traditional LRP in intraoperative operation and postoperative recovery in the treatment of prostate cancer. However,its high costs may limit the use. RALRP will have a better prospect with the development of robots made in China.

关 键 词：机器人 腹腔镜 前列腺癌根治术 术后尿控 肿瘤切缘阳性率 

分 类 号：R737.25[医药卫生—肿瘤]