机器人辅助腹腔镜根治性前列腺切除术中不同膀胱颈分离技术的临床应用  

Clinical application of different bladder neck separation techniques in robot-assisted laparoscopic radical prostatectomy

作　　者：范世达 任尚青 周放 陈正军 杨文钊 吕倩 李安 冯华林 王强 聂钰 王东 Fan Shida;Ren Shangqing;Zhou Fang;Chen Zhengjun;Yang Wenzhao;Lyu Qian;Li An;Feng Hualin;Wang Qiang;Nie Yu;Wang Dong(Department of Robotic Minimally Invasive Surgery Center,Sichuan Academy of Medical Sciences&Sichuan Provincial People’s Hospital,Chengdu 610072,China)

机构地区：[1]四川省医学科学院,四川省人民医院机器人微创中心,成都610072

出　　处：《中华泌尿外科杂志》2020年第3期194-199,共6页Chinese Journal of Urology

摘　　要：目的:探讨机器人辅助腹腔镜根治性前列腺切除术(RARP)中不同膀胱颈分离方式的临床效果。方法:回顾性分析四川省人民医院2014年10月至2018年10月收治的750例局限性前列腺癌并接受RARP患者的病例资料。根据术中膀胱颈分离方式将患者分为4组。A组500例,年龄63(62.5~67.0)岁,PSA 13(9.0~22.0)ng/ml,穿刺Gleason评分6.9(5~9)分,前列腺体积66(42~78)ml,体质指数≤25 kg/m 2300例(60%),>25 kg/m 2200例(40%);T 1c期75例(15.0%),T 2a^2b期255例(51.0%),T 2c^3a期170例(34.0%);术中采用顺向剥离方式,在膀胱颈前部12点部位行1 cm切口,切断逼尿肌并切开膀胱颈。B组133例,年龄65(61~68)岁,PSA7.4(6.4~26.0)ng/ml,穿刺Gleason评分7(6~12)分,前列腺体积70(50~89)ml,体质指数≤25 kg/m 285例(63.9%),>25 kg/m 248例(36.1%);T 1c期43例(32.3%),T 2a^2b期56例(42.1%),T 2c^3a期34例(25.6%);术中采用T形切开膀胱颈方式,正确识别膀胱与前列腺交界,T形切开膀胱颈前壁。C组81例,年龄66(64.5~70.5)岁,PSA 6.2(5.3~27.0)ng/ml,穿刺Gleason评分9(8~16)分,前列腺体积53(43~72)ml,体质指数≤25 kg/m 252例(39.1%),>25 kg/m 229例(60.9%);T 1c期39例(48.1%),T 2a^2b期27例(33.3%),T 2c^3a期15例(18.6%);术中采用顺向剥离方式联合T形切开膀胱颈方式。D组36例,年龄62(59.5~66.5)岁,PSA 14(8.4~21.0)ng/ml,穿刺Gleason评分10(6~18)分,前列腺体积80(68~92)ml,体质指数≤25 kg/m 215例(42.0%),>25 kg/m 221例(58.0%);T 1c期6例(16.6%),T 2a^2b期17例(47.2%),T 2c^3a期13例(36.2%);术中采用侧方会师方式,沿一侧的膀胱颈外侧及前列腺侧后韧带内侧进行分离,与事先建立的狄氏间隙汇合。4组患者的年龄、PSA、Gleason评分、前列腺体积、体质指数及临床分期差异均无统计学意义(P>0.05)。所有手术均由同一名术者完成。比较4组的手术时间、出血量、吻合时间、术后住院时间、术后并发症、近端切缘阳性率、尿管留置时间、术后6个月尿控率。结果:本研究750例手术�Objective To investigate the clinical effect of different bladder neck separation methods in robot-assisted laparoscopic radical prostatectomy(RARP).Methods To retrospective analysis the data of robot-assisted laparoscopic radical prostatectomy(RARP)in our center from October,2014 to October,2018.All operations were performed by the same urologist.According to the different methods of bladder neck separationAccording to the different methods of bladder neck separation,all the patients were divided into four groups.Group A routine forward peeling method(500 cases):Make a 1cm incision at 12 o'clock on the front of the bladder neck,cut off the detrusor muscle and cut the bladder neck.Group B T-cut incision of the bladder neck(133 cases):identify the bladder and prostate Junction,T-shaped incision of the anterior wall of the bladder neck.Group C conventional stripping method combined with T-shaped incision of the bladder neck(81 cases).Group D lateral approach(36 cases):along the lateral side of the bladder neck and the medial posterior ligament of the prostate is separated and merges with the previously established Dirichlet space.The general data of patients were analyzed statistically.The average ages of groups A,B,C,and D were 63 years(62.5 to 67 years),65 years(61 to 68 years),66 years(64.5 to 70.5 years),and 62 years(59.5 to 66.5 years)respectively,there was no statistical significance difference in terms of age in 4 groups(P>0.05);PSA is 13 ng/ml(9.0 to 22 ng/ml),7.4 ng/ml(6.4 to 26.0 ng/ml),6.2 ng/ml(5.3 to 27.0 ng/ml),14ng/ml(8.4 to 21.0 ng/ml),(P>0.05);Gleason scores of puncture were 6.9(5 to 9),7(6 to 12),9(8 to 16),10(6 to 18),(P>0.05);the prostate volume was 66ml(42 to 78 ml),70ml(50 to 89 ml),53ml(43 to 72 ml),80 ml(68 to 92 ml),(P>0.05);the proportions of body mass index≤25 kg/m2 were 60.0%,63.9%,39.1%,42.0%,and>25 kg/m2 were 40%,36.1%,60.9%,and 58.0%,respectively,(P>0.05).The operation time,bleeding volume,anastomosis time,postoperative hospital stay,postoperative complications,positive rate of prox

关 键 词：前列腺肿瘤 机器人手术系统 膀胱颈分离方式 

分 类 号：R737[医药卫生—肿瘤] TP242[医药卫生—临床医学]