机器人辅助根治性前列腺切除术切缘阳性的影响因素研究  

Study on positive surgical margin after robot-assisted radical laparoscopic prostatectomy

作　　者：冯源康 李翔 杨锦建[1] 王军[1] 刘若阳[1] 丁映辉 黄珍林 李松超[1] 张正果 贾占奎[1] FENG Yuankang;LI Xiang;YANG Jinjian;WANG Jun;LIU Ruoyang;DING Yinghui;HUANG Zhenlin;LI Songchao;ZHANG Zhengguo;JIA Zhankui(Department of Urinary Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院泌尿外科,河南郑州450052

出　　处：《机器人外科学杂志（中英文）》2021年第5期367-372,共6页Chinese Journal of Robotic Surgery

基　　金：河南省自然科学基金资助项目(182300410341)。

摘　　要：目的:探究机器人辅助腹腔镜根治性前列腺切除术(Robot-assisted radical laparoscopic prostatectomy,RLRP)后造成切缘病理阳性的一些影响因素,并讨论切缘阳性与尿控及生化复发的关系。方法:采用回顾性分析研究2018年7月~2020年11月郑州大学第一附属医院接受RLRP术患者86例的临床资料。按照PSA、前列腺突入膀胱长度(IPPL)等进行分组,分析各组切缘阳性率的差异。结果:86例患者的手术均在达芬奇辅助腹腔镜下顺利完成,无1例中转开放。分别经两位术者完成,其中术者A为41台,术者B为45台;手术平均出血量为(85.00±48.35)ml,手术平均时间为(187.35±65.23)min。术后病理结果均证实是前列腺癌,手术后发现切缘阳性36例(41.9%),术中行淋巴结清扫63例,其中20例为淋巴结阳性。将所有危险因素分组后进行单因素分析,对单变量分析得到的具有统计学意义的数据行Logistic回归分析,多变量分析结果提示术者(P=0.038)、术前PSA(P<0.001)、IPPL(P=0.02)、穿刺的Gleason分数(P=0.005)是造成手术切缘阳性的独立危险因素。术后79位患者得到随访,平均随访时间为(271.09±186.01)d,术后生化复发比例为16.5%,术后排尿控制比例为68.35%,手术切缘的病理阳性比例与排尿控制(P=0.002)和生化复发(P<0.001)存在相关性。结论:操作者、PSA、IPPL和Gleason分数是造成RLRP术后切缘阳性的独立危险要素,切缘阳性与排尿控制和生化复发存在相关性。Objective:To investigate the factors influencing positive posterior margin after robot-assisted radical laparoscopic prostatectomy(RLRP),and evaluate the relationship between positive posterior margin and biochemical recurrence or urinary control.Methods:The clinical data of 86 patients underwent RLRP in the First Affiliated Hospital of Zhengzhou University from July 2018 to November 2020 were retrospectively analyzed.The differences of incidence of positive posterior margin in different groups were analyzed based on PSA,intravesical prostatic protrusion length(IPPL),preoperative clinical stage and other indicators.Results:All the 86 cases were successfully completed under RLRP without conversion to open surgery.41 cases were performed by Doctor A,and 45cases by Doctor B,with an average operative time(187.35±65.23)min and average intraoperative bleeding(85.00±48.35)ml.All patients were confirmed prostate cancer after surgery by pathological findings,and 36 cases of positive surgical margin were found after surgery.63 cases of lymph node dissection were performed and 20 cases of lymph node-positive were found.Risk factors were divided into groups and executed with univariate analysis.The logistic regression analysis was used to process statistically meaningful univariate data.Multivariate analyses suggested that Performer(P=0.038),Preoperative PSA(P<0.001),IPPL(P=0.02),Gleason score(P=0.005)were isolated risk factors.79 cases were given follow-up after operation,with and average follow-up time of(271.09±186.01)days.The biochemical recurrence rate was 16.46%,postoperative urinary control rate was 68.35%.A correlation between positive margin and biochemical recurrence(P<0.001)or urinary control(P=0.002)was found in this research.Conclusion:Performer,preoperative PSA、IPPL and preoperative puncture pathological Gleason score are independent risk factors to positive margin after RLRP,which is correlated with biochemical recurrence and urinary control.

关 键 词：前列腺突入膀胱长度 机器人手术 前列腺肿瘤 切缘阳性 

分 类 号：R608[医药卫生—外科学] R697[医药卫生—临床医学]