机器人辅助腹腔镜前列腺癌根治术(RALP)与开放性耻骨后前列腺癌根治术(RRP)的5年肿瘤学效果对比  

Comparison of the 5-year oncological outcome of robot-assisted laparoscopic radical prostatectomy(RALP)and open retropubic radical prostatectomy(RRP)

作　　者：沈志远 钱伟庆 丁海雍 孙忠全 SHEN Zhi-yuan;QIAN Wei-qing;DING Hai-yong;SUN Zhong-quan(Department of Urology,Huadong Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华东医院泌尿外科

出　　处：《复旦学报（医学版）》2020年第1期7-11,30,共6页Fudan University Journal of Medical Sciences

摘　　要：目的分析机器人辅助腹腔镜前列腺癌根治术(robot-assisted laparoscopic radical prostatectomy,RALP与开放性耻骨后前列腺癌根治术(open retropubic radical prostatectomy,RRP)治疗局限性前列腺癌的5年肿瘤学效果。方法收集复旦大学附属华东医院泌尿外科2009年7月至2014年3月同期接受RALP或RRP并获得随访的95例患者临床资料,比较两种术式的手术时间、术中失血量及输血比例、术后病理、生化复发率等指标。结果 95例手术均获成功,RALP组无中转开放。RALP组与RRP组手术时间分别为212.3与166.8 min(P<0.05),术中失血量分别为237.3与557.3 mL(P<0.05);术中输血比例分别为16.7%与78.7%(P<0.05);手术切缘阳性率分别为22.0%与7.8%(P<0.05),1年尿控率分别为79.5%和84.7%,6个月、1年、2年、3年、4年、5年生化复发率分别为6.2%和4.3%、18.8%和6.4%、25.0%和14.9%、29.2%和21.3%、31.2%和21.3%、31.2%和23.4%。两组5年内的生化复发率差异无统计学意义。结论 RALP具有损伤小、出血少、输血少的优点,但手术时间长于RRP。两种术式的尿控、手术切缘阳性率及5年长期肿瘤学效果等相似。Objective To evaluate the five-year outcome of robot assisted laparoscopic radical prostatectomy(RALP)compared with open retropubic radical prostatectomy(RRP). Methods During Jul.2009 and Mar. 2014,95 patients from Department of Urology,Huadong Hospital were involved.The clinical data was collected retrospectively and analyzed,including preoperative parameter,total operation time,blood loss,blood transfusion rate,postoperative pathology,continence and biochemical recurrence.Results All cases were successfully performed,without RALP conversing to open surgery. In RALP group and RRP group,the meaning operation time was respectively 212.3 and 166.8 min(P<0.05),the mean intraoperative blood loss was respectively 237.3 and 557.3 mL(P<0.05),the rate of intraoperative blood transfusion was respectively 16.7% and 78.7%(P<0.05),the postoperative positive margin rate was respectively 22.0% and 7.8%(P<0.05),and the 1-year urinary continence rate was respectively79.5% and 84.7%. In RALP group,the 6-month,1-year,2-year,3-year,4-year and 5-year biochemical recurrence rate was respectively 6.2%,18.8%,25.0%,29.3%,31.2% and 31.2%. In RRP group,the 6-month,1-year,2-year,3-year,4-year and 5-year biochemical recurrence rate was respectively 4.3%,6.4%,14.9%,21.3%,21.3% and 23.4%. There was no statistical difference in biochemical recurrence and continence. Conclusions Robot-assisted radical prostatectomy possessed advantages of less injured,and less bleeding,and less blood transfusion.However,the operation time is relatively inferiors to open surgery.The positive margin rates,the effect of postoperative oncology and continence of urine was similar to open surgery.

关 键 词：前列腺癌 机器人 腹腔镜 耻骨后前列腺癌根治术 尿控 生化复发 

分 类 号：R737.25[医药卫生—肿瘤]