Hood技术在机器人辅助根治性前列腺切除术中的应用及疗效分析  

The application of Hood technique in rohotic-assisted radical prostatectomy

作　　者：杨俊[1] 胡嘏 管维[1] 刘征 王志华 胡志全[1] 庄乾元[1] 王少刚[1] Yang Jun;Hu Jia;Giuan Wei;Liu Zheng;Wang Zhihua;Hu Zhiquan;Zhuang Qianywan;Wang Shaogang(Department of Urology,Tongji Hospital,Tongji Medical College,Huazhong Unirersity of Science&Technology,Wiuhun 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院泌尿外科,武汉430030

出　　处：《中华泌尿外科杂志》2022年第3期176-180,共5页Chinese Journal of Urology

摘　　要：目的探讨Hood技术在机器人辅助根治性前列腺切除术(RARP)中应用的可行性及安全性。方法回顾性分析2020年6月至2021年3月华中科技大学同济医学院附属同济医院收治的24例采用Hood技术行RARP患者的临床资料。年龄平均67.8(57~76)岁,体质指数平均25.17(18.31~32.54)kg/m^(2),术前总前列腺特异性抗原平均18.36(4.21~67.57)ng/ml。所有患者术前穿刺均明确诊断,Gleason评分平均7.3(6~8)分。术前临床分期T_(1c)期1例,T_(2a)期5例,T_(2b)期4例,T_(2c)期14例。所有患者均行RARP,术中采用Hood技术,其特点为经前入路保留Retzius间隙,手术操作层面紧贴膀胱前壁,耻骨后骨盆结构及前列腺外膜轮廓均不显露。分析患者手术结果、术后病理及随访情况。结果24例手术均顺利完成,无中转开放手术。手术时间(机械臂操作时间)平均84.5(63~110)min,出血量平均75.3(20~180)ml。术后19例留置引流管,平均留置3.7(3~5)d,5例未留置引流管。术后住院时间平均7.1(4~11)d,术后尿管留置时间平均7.3(6~9)d。23例拔除尿管后即刻实现尿控,1例术后2周实现尿控。术后病理:pT_(2a)期4例,pT_(2b)期6例,pT_(2c)期14例;Gleason评分平均7.9(6~9)分。无切缘阳性病例。术后随访3~12个月,无因手术并发症再次入院病例,所有患者末次随访均无肿瘤复发。结论RARP术中应用Hood技术,可简化Retzius间隙保留步骤,手术切缘阳性率低,术后即刻尿控效果好。Objective To explore the feasibility,safety and short-term effect uf the Hood technique in rohotic-assisted radical prostatectomy(HARP).Methods The data of 24 patients with localized prostate cancer undenvrnt KARP with Hood teclinique From June 2020 to March 2021 were retrospectively reviewed.Hie mean age was 67.8(57-76)years,and the mean IkmIv mass index was 25.17(18.31-32.54)kg/m^(2).Phe mean tPSA value was 18.36(4.21-67.57)ng/ml and the mean hiopsy Gleason score was 7.3(6-8).In term of the clinical T stage,the 24 cases were composed ol the T_(1c)stage in 1 case,T_(2a)stage in 5 cases,T_(2b)stage in 4 cases and T_(2c)stcige in 14 cases.During:Hood technicjue,the anterior bladder were limitedly isolated without exposing the outline of pelvis and prostate.Results All the cases were complcled rohoticallv without conversion,transfusion or pexsitive surgical margin.Fhe average robol-assisted operation lime was 84.5(63-110)mins.Estimated blood loss was 75.3(20-180)ml.The average time for maintaining the drain was 3.7(3-5)days.The mean postoperative hospital stay was 7.1(4-11)days.The mean calheterization time was 7.3(6-9)days after surgery.23 patients achieved conlinence immediately after catlieter removal,while 1 patient had conlinence full-recoven 2 weeks iifter surgery.The mean surgical Gleason score was 7.9(6-9).In term of the surgical T stage,the 24 cases were composed of the pT_(2a)stage in 4 case,T_(2b)stase in 6 cases,T_(2c)stage in 14 cases.During 3-12 months'follow-up,no hiochemiral recurrence was found.Conclusions Hood technique were safe and valid in PARP with excellent inmiediate conitinence recovery.It facilitaled Retzius sparing in a convenient approach with low positive surgical margin late.

关 键 词：前列腺肿瘤 癌 机器人手术 Hood技术 即刻尿控 

分 类 号：R737.25[医药卫生—肿瘤]