改良前入路保留Retzius间隙机器人辅助腹腔镜根治性前列腺筋膜内切除术在10例前列腺癌患者的应用  

Efficacy of modified anterior robot-assisted laparoscopic radical prostatectomy with preservation of Retzius space in 10 cases

作　　者：李辉 杨超 汪凯红 张亿达[1] 郭炬[1] 傅斌[1] 曹润福[1] LI Hui;YANG Chao;WANG Kaihong;ZHANG Yida;GUO Ju;FU Bin;CAO Runfu(Department of Urology,The First Affiliated Hospital of Nanchang University,Nanchang 330000,China)

机构地区：[1]南昌大学第一附属医院泌尿外科,江西南昌330000

出　　处：《现代泌尿外科杂志》2023年第3期201-205,共5页Journal of Modern Urology

基　　金：江西省教育厅科学技术研究项目(No.GJJ210220)。

摘　　要：目的探讨改良前入路保留Retzius间隙机器人辅助腹腔镜根治性前列腺筋膜内切除(RALRP)技术的安全性、可行性及临床疗效。方法回顾性分析2021年6月—2022年3月南昌大学第一附属医院泌尿外科收治的10例采用改良前入路保留Retzius间隙技术行RALRP患者的临床资料。统计患者的术前资料、术中情况以及术后和随访情况。结果10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(98.6±47.7)min,出血量平均(105.0±57.3)mL。术后留置引流管时间平均(5.3±1.3)d,术后留置尿管时间平均(7.2±0.8)d,术后住院时间平均(9.2±2.2)d。6例患者拔除尿管后即刻实现尿控,2例患者拔管后2周恢复尿控,2例患者在拔管后3月恢复尿控。术后病理:pT2a期1例,pT2b期2例,pT2c期7例;Gleason评分6~7分;术后切缘均为阴性。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。结论改良前入路保留Retzius间隙RALRP术,安全可行,术中术后未出现严重并发症,术后早期尿控效果与后入路相当。Objective To investigate the safety,feasibility and clinical efficacy of modified anterior robot-assisted laparoscopic radical prostatectomy(RALRP)with preservation of Retzius space.Methods The clinical data of 10 patients who underwent RALRP using the modified anterior approach to preserve the Retzius space in our hospital during June 2021 and March 2022 were retrospectively analyzed,including the preoperative,intraoperative,postoperative and follow-up data.Results All operations were successful without conversion to open surgery.The average operation time(robotic arm operation time)was(98.6±47.7)min,blood loss(105.0±57.3)mL,postoperative drainage tube indwelling time(5.3±1.3)d,postoperative urinary catheter indwelling time(7.2±0.8)d,and postoperative hospital stay(9.2±2.2)d.Urinary continence was achieved immediately after removal of the urinary catheter in 6 patients,2 patients recovered 2 weeks after extubation,and 2 patients recovered 3 months after extubation.Postoperative pathology showed pT2a stage in 1 case,pT2b stage in 2 cases,and pT2c stage in 7 cases;Gleason score was 6-7 points;all postoperative resection margins were negative.During the follow-up of 3-12 months,no tumor recurrence was observed,and no patient was readmitted due to surgical complications.Conclusion RALRP with modified anterior approach to preserve the Retzius space is safe and feasible,with no serious complications during and after surgery,and the early postoperative urinary continence effect is comparable to that of the posterior approach.

关 键 词：前列腺根治术 机器人手术 Retzius间隙 手术入路 前列腺解剖 

分 类 号：R737.25[医药卫生—肿瘤]