机器人腹腔镜后入路完全筋膜内根治性前列腺切除术治疗早期前列腺癌  

Robot-assisted radical prostatectomy via posterior and completely intrafascial for organ-confined prostate cancer

作　　者：李腾成[1] 谭益元 黄群雄 吴杰英[1] 肖恒军[1] 胡成[1] 李茂胤 高新[1] 狄金明[1] Li Tengcheng;Tan Yiyuan;Huang Qunxiong;Wu Jieying;Xiao Hengjun;Hu Cheng;Li Maoyin;Gao Xin;Di Jinming(Department of Urology,the Third Afiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;不详)

机构地区：[1]中山大学附属第三医院泌尿外科,广州510630 [2]韶关市第一人民医院泌尿外科,广东512000

出　　处：《中华腔镜泌尿外科杂志（电子版）》2023年第5期452-456,共5页Chinese Journal of Endourology(Electronic Edition)

基　　金：国家自然科学基金面上项目(82272840);广东省自然科学基金(2021A1515010129)。

摘　　要：目的探讨机器人腹腔镜后入路完全筋膜内根治性前列腺切除术治疗局限性早期前列腺癌(PCa)的技术要领,并评估其肿瘤学和功能结果。方法15例T_(1-2b)N_(0)M_(0)的PCa患者行机器人腹腔镜后入路完全筋膜内根治性前列腺切除术,术前行国际勃起功能指数(IIEF)-5评分。患者全麻后取平卧头低脚高位,连接机器人系统,显露道格拉斯窝,游离双侧输精管和精囊腺;紧贴前列腺后方、侧方和前方依次钝性推开狄氏筋膜前层、离断侧韧带和脏层盆筋膜;显露并离断尿道;双针连续吻合膀胱颈后尿道。记录围手术期资料和功能结果数据。所有患者术后定期随访PSA检测、日常尿垫和IEF-5评分。结果15例患者成功完成手术,中位手术时间86(65~116)min,术中失血量20(10~60)ml,围手术期无严重并发症发生。术后病理均<pT_(2e),Gleason评分<8,无切缘阳性病例,术后随访均无生化复发。导尿管中位停留时间为7(6~8)d,13例患者在拔除导尿管后即刻控尿(0片/天),2例患者拔除导尿管后出现轻度失禁(2~3片/d),2周内全部恢复控尿。9例患者在术后6个月内恢复勃起功能,IIEF-5评分均>18。结论机器人腹腔镜后入路完全筋膜内根治性前列腺切除术治疗中低风险局限性早期PCa患者安全有效,近期随访控瘤、控尿和勃起功能恢复效果满意。Objective To explore the technical essentials of robot-assisted radical prostatectomy via posterior and completely intrafascial for organ-confined prostate cancer,and to evaluate the oncological and functional outcomes.Methods Fifteen prostate cancer patients with T_(1-2b)N_(0)M_(0) were scheduled for robot-assisted radical prostatectomy via posterior and completely intrafascial approach,and their international index of erectile function(IIEF)were performed before operation.All patient was placed in a supine position and the robotic system was established.Firstly,expose the Douglas fossa,free bilateral vas deferens and seminal vesicles,blunt dissection of the Denonvillier fascia,severed lateral ligament and visceral pelvic fascia,then exposed and disconnected urethra,continuous suture bladder neck urethra.Perioperative complications and functional outcome data were recorded.All patients were regularly followed up for tPSA testing,daily urine pads and IIEF-5 scores.Resulsts All of the 15 patients were successfully completed the operations.The median(range)operation time was 86(65-116)min,and estimated blood loss was 20(10-60)ml,and no serious complications occurred.Postoperative pathology was<pT_(2e),Gleason score<8,no cases of positive surgical margins,and no biochemical recurrence(BCR)in postoperative follow-up.Catheter were removed after a median(range)time of 7(6-8)d,13 patients were immediately continent(O pads/d),and two patients had mild incontinence(2-3 pads/d).All patients were observed as continent within next two weeks.Nine patients achieved a satisfactory erection at 6 months postoperatively,with an IIEF-5 score>18.Conclusions Robot-assisted radical prostatectomy via posterior and completely intrafascial approach is technically feasible for patients with low-risk localized prostate cancer and demonstrates promising functional outcomes regarding continence and potency.

关 键 词：前列腺肿瘤 机器人 前列腺切除术 筋膜内 尿失禁 勃起功能障碍 

分 类 号：R737.25[医药卫生—肿瘤]