经腹膜外途径US-RASP治疗大体积BPH的初步经验  被引量:1

Extraperitoneal approach robotic-assisted urethra-sparing simple prostatectomy for large-gland benign prostatic hyperplasia: initial experience

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作  者:屈峰[1] 张古田[1] 邓永明[1] 梁静[1] 刘宁[1] 杨荣[1] 徐林锋[1] 李笑弓[1] 甘卫东[1] 郭宏骞[1] Qu Feng;Zhang Gutian;Deng Yongming;Liang Jing;Liu Ning;Yang Rong;Xu Linfeng;Li Xiaogong;Gan Weidong;Guo Hongqian(Department of Urology,Nanjing Drum Tower Hospital,Medical School of Nanjing University,Institute of Urology,Nanjing University,Nanjing 210008,China)

机构地区:[1]南京大学医学院附属鼓楼医院泌尿外科南京大学泌尿外科学研究所,南京210008

出  处:《中华泌尿外科杂志》2019年第10期757-762,共6页Chinese Journal of Urology

基  金:南京市医学科技发展资金重点项目(YKK15081);南京市医学科技发展资金资助项目(QRX17049).

摘  要:目的探讨经腹膜外途径机器人辅助保留尿道的单纯前列腺切除术(US-RASP)治疗大体积(>100ml)良性前列腺增生(BPH)的可行性及临床应用价值。方法回顾性分析2015年8月至2018年4月南京大学医学院附属鼓楼医院采用US-RASP治疗的32例大体积BPH患者的临床资料。中位年龄73岁(59~80岁),体质指数24.9kg/m^2(19.3~34.8kg/m^2),前列腺体积152.0ml(119.0~223.1ml),残余尿量145ml(0~280ml),术前PSA13.7ng/ml(5.2~27.3ng/ml)。32例中4例术前导尿。32例中位国际前列腺症状评分(IPSS)27分(23~33分),最大尿流率(Qmax)5.9ml/s(2.5~7.8ml/s),最大尿量110ml(80~210ml),生命质量评分(QOL)5分(3~6分)。17例术前有勃起功能,国际勃起功能专项评分(IIEF-EF)27分(26~29分)。比较术前与术后3、12个月IPSS、Qmax、残余尿量、最大尿量、QOL、IIEF-EF等指标的差异,分析评估手术疗效。结果32例均顺利完成手术,未中转开放手术。中位手术时间180min(115~240min),失血量300ml(100~400ml),术后第1天血红蛋白下降值17g/L(5~38g/L)。术后留置引流管5d(4~7d),留置尿管7d(5~12d),住院时间8d(6~14d),切除前列腺重量107.7g(79.8~147.4g),前列腺切除比例64.2%(49.4%~86.2%)。32例术后中位随访17个月(12~44个月)。术后3个月及12个月IPSS评分[6分(4~18分)和1分(0~3分)]、Qmax[17.3ml/s(13.8~21.1ml/s)和20.1ml/s(17.9~24.1ml/s)]、最大尿量[167ml(140~310ml)和205ml(176~305ml)]、残余尿量[50ml(0~61ml)和24ml(0~35ml)]及QOL[1分(0~3分)和1分(0~2分)]均较术前明显改善,差异均有统计学意义(P<0.01)。术前有勃起功能的17例患者,术后勃起功能未受损,其中14例(82.4%)维持满意的顺行射精,术后3、12个月的IIEF-EF[26(26~28)分和27(27~29)分]与术前比较,差异均无统计学意义(P>0.05)。无严重并发症及永久性尿失禁发生。结论经腹膜外途径US-RASP治疗大体积BPH是一种安全、有效的微创方法,保留尿道技术可显著改善术后排尿功能并保留性功能,尤其是射精功�Objective To report our initial experience with extraperitoneal approach Robotic-Assisted Urethra-sparing simple prostatectomy(US-RASP)on large-gland (>100 ml) benign prostatic hyperplasia(BPH). Methods From August 2015 to April 2018, 32 patients with large volume prostate underwent US-RASP performed by single surgical team were retrospectively reviewed. The patient's median age was 73 (range 59-80) years, and median BMI was 24.9 (19.3-34.8 ) kg/m^2, The estimated prostate volume(V), postvoid residual volume(PV) by transrectal ultrasonography and PSA were 152.0(119.0-223.1)ml, 145(0-280)ml and 13.7(5.2-27.3)ng/ml, respectively. Four of 32 patients underwent preoperative urinary catheterization. The perioperative functional parameters including international prostate symptom score (IPSS) questionnaire, maximum flow rate (Qmax), maximum voided volume(Vmax), quality of life questionnaires (QOL) and International Index of erectile function-erectile function (IIEF-EF) were 27(23-33), 5.9 (2.5-7.8) ml/s, 110 (80-210)ml, 5(3-6), and 27(26-29), respectively. Functional parameters including IPSS, QOL, Qmax, Vmax, PV and IIEF-EF were compared and analyzed at 3 and 12 months postoperatively during the following-up. Results The US-RASP was completed in all 32 patients and no open conversion. Median operation time was 180 (115-240) min, the estimated blood loss was 300(range 100 to 400)ml, Hemoglobin loss was 17(5-38)g/L. The median Foley catheterization time was 7 (5-12) days and drainage was removed after a median of 5 (4-7) days with median hospital stay of 8(6-14)days. Median specimen weight on pathological examination was 107.7 (79.8-147.4)g with median of 64.2%(49.4%-86.2%) resection ratio. At 3-mo follow-up, median IPSS score, Qmax, Vmax, PV and QOL were 6(4-18), 17.3 (13.8-21.1)ml/s, 167(140-310)ml, 50(0-61)ml, 1(0-3), respectively. At 12-mo follow-up, median IPSS score, Qmax, Vmax, PV and QOL were 4(1-9), 20.1 (17.9-24.1)ml/s, 205(176-305)ml, 24(0-35)ml and 1(0-2), respectively. All patients showed great improvement

关 键 词:前列腺增生 前列腺切除术 机器人手术 腹膜外途径 保留尿道 

分 类 号:R699[医药卫生—泌尿科学]

 

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