多种路径机器人辅助单孔腹腔镜根治性前列腺切除术的初步疗效  

Single-port robot-assisted laparoscopic radical prostatectomy through different approaches:initial experience and outcomes

作　　者：杜巍 徐伟东[1] 杨悦[1] 常易凡 陆晓俊 肖雨田 张晓敏 闫石 王野[1] 刘智勇[1] 任善成[1] Du Wei;Xu Weidong;Yang Yue;Chang Yifan;Lu Xiaojun;Xiao Yutian;Zhang Xiaomin;Yan Shi;Wang Ye;Liu Zhiyong;Ren Shancheng(Department of Urology,Shanghai Changhai Hospital,Shanghai 200433,China)

机构地区：[1]上海长海医院泌尿外科,200433

出　　处：《中华泌尿外科杂志》2020年第11期815-819,共5页Chinese Journal of Urology

摘　　要：目的评估多种路径机器人辅助单孔腹腔镜根治性前列腺切除术的可行性和有效性。方法回顾性分析上海长海医院2018年5月至2020年6月单术者开展的115例机器人辅助单孔腹腔镜根治性前列腺切除术患者的临床资料。患者平均年龄67(52~84)岁,术前平均体质指数24.44(19.52~32.33)kg/m2,术前中位PSA 9.77(6.54,15.32)ng/ml。临床分期<cT3a期111例,cT3a期4例。115例均行机器人辅助单孔腹腔镜根治性前列腺切除术,其中采用经腹膜外入路92例,经会阴入路10例,经膀胱入路13例。经腹膜外入路、经会阴入路患者中分别有6、1例腹部手术史;经膀胱入路患者中6例有盆腔手术史。记录手术情况、术后并发症、病理及随访结果。结果115例手术均顺利完成,无中转开放或增加手术操作孔。平均手术时间91.8(40~200)min,其中经腹膜外、经会阴、经膀胱入路手术时间分别为88.0(40~200)、132.5(90~190)、87.3(60~150)min。术中平均出血量85.5(45~400)ml,其中经腹膜外、经会阴、经膀胱入路出血量分别为77.6(50~200)、178.0(80~400)、70.4(45~150)ml。术后病理分期≥pT3a期45例,<pT3a期70例。整体切缘阳性率为17.4%(20/115),其中≥pT3a期患者切缘阳性率为31.1%(14/45),<pT3a期患者切缘阳性率为8.6%(6/70)。病理Gleason评分6分6例,3+4分45例,4+3分52例,≥8分8例;病理类型均为腺泡腺癌。术后平均住院时间3(1~7)d。115例平均随访时间10.4(3~21)个月,术后1个月中位PSA 0.03(0.01,0.05)ng/ml,术后3个月102例(88.7%)每日应用尿垫≤1片。结论经腹膜外入路、经会阴入路和经膀胱入路的机器人辅助单孔腹腔镜根治性前列腺切除术对局限性前列腺癌具有较好的美容效果,术后恢复快,且短期尿控和瘤控效果较好。Objective To evaluate the feasibility and effectiveness of sing-port robot-assisted laparoscopic radical prostatectomy(sp-RALP)through different approaches.Methods The data of 115 patients who underwent sp-RALP through different approaches from May 2018 to June 2020 were retrospectively reviewed.In our study,92 cases through extraperitoneal approach,10 through transperineal approach and 13 though transvesical approach.Preoperative,intraoperative and early postoperative outcomes after various approaches were collected and analyzed.The mean age was 67(52-84)years,mean preoperative body mass index was 24.44(19.52-32.33)kg/m2.Patients were graded as cT1-3aN0M0 with no signs of regional lymph node invasion or distal metastasis.The median preoperative PSA was 9.77(6.54,15.32)ng/ml.Results All 115 sp-RALP were successfully completed with no conversion to open surgery or additional ports being placed.The mean operative time was 91.8(40-200)min,with 88.0(40-200)min for extraperitoneal approach,132.5(90-190)min for transperineal approach and 87.3(60-150)min for transvesical approach.The mean estimated blood loss was 85.5(45-400)ml,with 77.6(50-200)ml for extraperitoneal approach,178.0(80-400)ml for transperineal approach and 70.4(45-150)ml for transvesical approach.Of the 115 patients,60.9%(70/115)were<pT3a,39.1%(45/115)were≥pT3a.Positive margin(PSM)rate was 17.4%(20/115),with 31.1%(14/45)for≥T3a group,8.6%(6/70)for<T3a group.Postoperative pathology revealed a Gleason score of 3+3 in 6 patients,3+4 in 45 patients,4+3 in 52 patients,and≥8 in 2 patients.Mean hospital stay was 3(1-7)d.Median postoperative PSA was 0.03(0.01,0.05)ng/ml at 1 month postoperatively,and 88.7%patients reported less than 1 pad per day at 3 month postoperatively.Conclusions With several advantages,such as better cosmesis,postoperative fewer pain,and better recovery as well as comparable oncological outcomes in the short-term follow-up,sp-RALP through various approaches is a feasible and effective procedure for organ-confined prostate cancer.

关 键 词：前列腺肿瘤 癌 单孔手术 根治性前列腺切除术 机器人手术 

分 类 号：R737.25[医药卫生—肿瘤]