DVC免缝扎技术在机器人辅助前列腺癌根治术中的应用  

Deep dorsal vein complex ligation-free technique in robot-assisted radical prostatectomy for prostate cancer

作　　者：程旭 黄智超[1] 彭谋[1] 王荫槐[1] CHENG Xu;HAUNG Zhi-chao;PENG Mou;WANG Yin-huai(Department of Urology,The Second Xiangya Hospital,Central South University,Changsha,Hunan 410011,China)

机构地区：[1]中南大学湘雅二医院泌尿外科,湖南长沙410011

出　　处：《中华男科学杂志》2020年第6期528-531,共4页National Journal of Andrology

摘　　要：目的:探究机器人辅助前列腺癌根治术(RARP)中免缝扎背深静脉复合体(DVC)对术中失血、肿瘤控制效果、术后控尿功能恢复的影响。方法:回顾性分析本院2015年10月至2019年6月接受机器人辅助前列腺癌根治术的154例患者的病历资料,比较免缝扎DVC和常规缝扎DVC患者的相关指标,包括手术时间、术中出血量、术中输血率、切缘阳性率以及拔管后即刻、1、3个月尿失禁发生率。结果:免缝扎DVC组(A组)40例,常规缝扎DVC组(B组)114例。两组患者一般特征,包括年龄、体重质量指数(BMI)、前列腺癌危险分级及美国麻醉师协会(ASA)分级无统计学差异(P>0.05)。A组平均手术时间107.20 min显著短于B组113.25 min(P<0.05)。两组反映术中失血的指标Z值改变量分别为2.11与1.24(P>0.05),术中输血率分别为10.0%与15.8%,两组术中失血无统计学差异(P>0.05)。A组术后总体切缘阳性率15.0%和前列腺尖部切缘阳性率7.5%均与B组的15.8%和8.8%无显著差异(P>0.05;P>0.05),两种DVC处理对肿瘤的控制效果没有区别。A组拔管后即刻尿失禁发生率2.5%,和拔管后1个月尿失禁发生率0,均显著低于B组的17.5%和14.0%(P<0.05;P<0.05),但拔管后3个月,A组(0)与B组(7.9%)无显著差异(P>0.05)。结论:机器人辅助前列腺癌根治术中该DVC免缝扎技术在不会导致术中失血增加且切除肿瘤效果相当的情况下,缩短手术时间,促进术后尿控功能恢复。Objective:To investigate the application of the deep dorsal vein complex(DVC)ligation-free technique in robot-assisted radical prostatectomy(RARP)and its effects on the intraoperative blood loss,incidence of positive surgical margin(PSM)and urinary continence of the patient.Methods:Totally 154 PCa patients underwent RARP between October 2015 and June 2019,40 with the DVC ligation-free technique(group A)and the other 114 by conventional DVC ligation(group B).We compared the baseline characteristics,operation time,intraoperative blood loss,blood transfusion rate,and postoperative incidences of PSM and urinary incontinence immediately and at 1 and 3 months after catheter removal between the two groups.Results:There were no statistically significant differences between the groups A and B in age,body mass index,PCa risk levels or American Scoiety of Anesthesiology(ASA)tumor grades(P>0.05),nor in intraoperative blood loss(ΔZ:[2.11±8.88]vs[1.24±14.70]g/L,P>0.05),blood transfusion rate(10.0%vs 15.8%,P>0.05),overall PSM incidence(15.0%vs 15.8%,P>0.05)or apical PSM rate(7.5%vs 8.8%,P>0.05).The mean operation time was remarkably shorter in group A than in B(107.20 min vs 113.25 min,P<0.05)and the postoperative incidence rate of urinary incontinence was markedly lower in the former than in the latter group immediately after(2.5%vs 17.5%,P<0.05)and at 1 month after catheter removal(0 vs 14.0%,P<0.05),but with no statistically significant difference between the two groups at 3 months(0 vs 7.9%,P>0.05).Conclusion:The DVC ligation-free technique in RARP can reduce the operation time and promote the recovery of urinary continence in PCa patients without increasing intraoperative blood loss and the incidence of PSM.

关 键 词：机器人 前列腺癌根治 DVC 出血 切缘阳性 控尿 

分 类 号：R737.25[医药卫生—肿瘤]