完全解剖性重建在机器人辅助根治性前列腺切除术中的应用研究  

Application of total anatomical reconstruction during robot-assisted radical prostatectomy

作　　者：邵金鹏 宋勇[1] 孙圣坤[1] 陈文政[1] 张帆[1] 赵健[1] 安子彦 符伟军[1] Shao Jinpeng;Song Yong;Sun Shengkun;Chen Wenzheng;Zhang Fan;Zhao Jian;An Ziyan;Fu Weijun(Senior Department of Urology,Third Medical Center of PLA General Hospital,Beijing 100039,China;graduate student of Medical School of Chinese PLA,Beijing 100853,China)

机构地区：[1]解放军总医院第三医学中心泌尿外科医学部,北京100039 [2]解放军医学院专业型研究生,北京100853

出　　处：《中华泌尿外科杂志》2023年第7期502-506,共5页Chinese Journal of Urology

摘　　要：目的探讨完全解剖性重建(TAR)在机器人辅助根治性前列腺切除术(RARP)中的应用效果。方法回顾性分析2018年1月至2021年12月解放军总医院第三医学中心单一术者行RARP的99例患者的临床资料,其中行TAR+膀胱尿道吻合(VUA)者38例,为TAR+VUA组;仅行VUA者61例,为VUA组。TAR+VUA组与VUA组患者年龄[65.5(60.8,71.0)岁与66.0(61.5,69.0)岁]、体质量指数[(24.92±2.65)kg/m^(2)与(25.51±2.80)kg/m^(2)]、前列腺体积[28.13(25.21,36.53)ml与26.33(19.75,47.84)ml]、PSA[15.67(9.02,31.49)ng/ml与14.58(9.23,30.06)ng/ml]、术前新辅助治疗[50.0%(19/38)与63.9%(39/61)]、Gleason评分(6/7/8/9~10分:8/16/5/9例与16/25/9/11例)、临床分期(T1/T2/T3期:4/29/5例与3/53/5例)差异均无统计学意义(P>0.05)。TAR技术主要步骤为:①后壁重建两层,缝合残留Denonvilliers筋膜与横纹括约肌背侧壁、背侧正中纤维脊(MDR),缝合膀胱前列腺肌肉(VPM)、膀胱颈头侧1~2 cm筋膜与MDR;②前壁重建一层,缝合膀胱颈部逼尿肌裙与尿道周围组织、盆内筋膜的脏层和壁层。VUA为连续缝合膀胱颈与尿道全层一圈。比较两组围手术期指标的差异。结果99例手术均顺利完成。TAR+VUA组与VUA组手术时间[(174.16±47.21)min与(188.70±45.39)min]、术中失血量[50(50,100)ml与100(50,100)ml]、术后并发症发生率[10.5%(4/38)与14.8%(9/61)]、病理分期[pT2/pT3~4期:25/12例与42/19例,P=0.895]、尿管留置时间[21.0(19.0,21.0)d与21.0(21.0,21.0)d]差异均无统计学意义(P>0.05),术后两组住院时间[6.0(5.0,6.0)d与7.0(6.0,7.5)d]差异有统计学意义(P<0.001)。术后随访12个月,TAR+VUA组与VUA组术后3个月尿控恢复率[86.8%(33/38)与65.6%(40/61)]差异有统计学意义(P=0.019),而两组术后1个月[47.4%(18/38)与45.9%(28/61)]、术后6个月[94.7%(36/38)与85.2%(52/61)]及术后12个月尿控恢复率[94.7%(36/38)与93.4%(57/61)]差异均无统计学意义(P>0.05)。结论TAR技术在RARP中具有良好的安全性,能够促进RARP术后短期�Objective To investigate the effect of total anatomical reconstruction(TAR)during robot-assisted radical prostatectomy(RARP).Methods The clinical data of 99 patients with RARP performed by a single doctor in our hospital from January 2018 to January 2021 were analyzed retrospectively.There were 38 patients in the TAR+vesicourethral anastomosis(VUA)group and 61 patients in the VUA group.There were no significant differences between the two groups in the age of patients[65.5(60.8,71.0)years vs.66.0(61.5,69.0)years],body mass index[(24.92±2.65)kg/m^(2) vs.(25.51±2.80)kg/m^(2)],prostate volume[28.13(25.21,36.53)ml vs.26.33(19.75,47.84)ml],PSA[15.67(9.02,31.49)ng/ml vs.14.58(9.23,30.06)ng/ml],neoadjuvant therapy[50.0%(19/38)vs.63.9%(39/61)],Gleason score(6/7/8/9-10 scores:8/16/5/9 cases vs.16/25/9/11 cases)and clinical T stage(T1/T2/T3 stage:4/29/5 cases vs.3/53/5 cases)(all P>0.05).The TAR technique was performed as follows.①The two layers of posterior reconstruction involved the residual Denonvilliers fascia,the striated sphincter and medial dorsal raphe(MDR),and the vesicoprostatic muscle(VPM),the fascia which was 1-2 cm from the cranial side of the bladder neck and MDR.②The one layer of anterior reconstruction involved detrusor apron,tissues around the urethra and the visceral and parietal layers of the endoplevic fascia.The VUA technique was suturing the bladder neck and urethra consecutively.Perioperative indexes were compared between the two groups.Results All 99 operations were successfully completed.There were no statistically significant differences between the TAR+VUA and VUA groups in operation time[(174.16±47.21)min vs.(188.70±45.39)min],blood loss[50(50,100)ml vs.100(50,100)ml],incidence of postoperative complications[10.5%(4/38)vs.14.8%(9/61)],phathological T stage[pT2/pT3~4 stage:25/12 cases vs.42/19 cases,P=0.895],and the time of indwelling catheter[21.0(19.0,21.0)d vs.21.0(21.0,21.0)d](all P>0.05).The difference in postoperative length of stay between the two groups was statistically signific

关 键 词：前列腺切除术 根治性 完全解剖性重建 尿控 

分 类 号：R737.25[医药卫生—肿瘤]