后入路机器人辅助逆行松解神经血管束的根治性前列腺切除术的疗效  

The efficiency of retzius-sparing robot-assisted laparoscopic radical prostatectomy with retrograde release of the neurovascular bundle

作　　者：王勇[1] 刘子豪[1] 温思萌[1] 刘洋[1] 黄华 周怡 牛远杰[1] Wang Yong;Liu Zihao;Wen Simeng;Liu Yang;Huang Hua;Zhou Yi;Niu Yuanjie(Department of Urology,The Second Hospital of Tianjin Medical University,Tianjin Institute of Urology,Tianjin Medical University,Tianjin 300211,China)

机构地区：[1]天津医科大学第二医院泌尿外科、天津市泌尿外科研究所,天津300211

出　　处：《中华泌尿外科杂志》2023年第12期906-910,共5页Chinese Journal of Urology

摘　　要：目的探讨后入路机器人辅助逆行松解神经血管束的根治性前列腺切除术的临床疗效。方法去回顾性分析2021年1月至2022年1月天津医科大学第二医院收治的113例前列腺癌患者的临床资料,所有患者均接受机器人辅助经后入路根治性前列腺切除术(RS-RARP),根据前列腺尖部包膜和神经血管束分离方向将患者分为优化组51例和标准组62例。优化RS-RARP是指钝性分离狄氏筋膜并向前游离至前列腺尖部,然后沿尖部左右分离,紧贴尖部和前列腺包膜逆向松解两侧神经血管束(NVB)。优化组和标准组的年龄分别为(67.5±6.4)岁和(67.7±6.1)岁,体质量指数分别为(25.0±3.2)kg/m^(2)和(24.9±3.1)kg/m^(2),前列腺体积分别为(42.8±15.4)ml和(41.0±17.9)ml,术前前列腺特异性抗原(PSA)分别为(13.5±13.1)ng/ml和(11.9±16.0)ng/ml,术前国际勃起功能指数-5(IIEF-5)评分分别为(15.0±4.0)分和(14.8±4.2)分,Gleason评分分别为(7.2±0.8)分和(7.1±0.9)分,差异均无统计学意义(P>0.05)。优化组和标准组临床分期cT_(2)期、cT,期分别为35例和40例、16例和22例;术前新辅助治疗分别为5例和11例,差异均无统计学意义(P>0.05)。比较两组的手术时间、术中出血量、术后引流管留置时间、住院时间、术后切缘阳性率和并发症情况。术后2周拔除尿管,随访患者尿控恢复情况,术后1个月随访IEF-5评分和PSA情况。即刻尿控定义为拔除尿管当日使用尿垫量≤1块。采用log-rank检验比较两组患者尿失禁情况的差异。结果本研究113例手术均顺利完成,中位随访时间16(14,21)个月,随访时间间隔≤3个月。优化组和标准组的手术时间分别为(79.7±26.6)min和(149.8±40.1)min,术中出血量分别为(54.9±24.7)ml和(110.0±83.2)ml,差异均有统计学意义(P<0.01)。优化组和标准组术后引流管留置时间分别为(5.3±2.1)d和(5.5±2.1)d,住院时间分别为(7.6±2.1)d和(8.5±2.3)d,术后病理切缘阳性率分别为19.6%(1Objective To explore the clinical efficacy of retzius-sparing robot-assisted laparoscopic radical prostatectomy with retrograde release of the neurovascular bundle.Methods From January 2021 to January 2022,the clinical data of 113 patients with retzius-sparing robot-assisted laparoscopic radical prostatectomy(RS-RARP)was retrospectively analyzed.The ages of the optimized group and the standard group were(67.5±6.4)years and(67.7±6.1)years,and the body mass index(BMI)was(25.0±3.2)kg/m^(2)and(24.9±3.1)kg/m^(2),respectively.The prostate volume was(42.8±15.4)ml and(41.0±17.9)ml,the preoperative PSA was(13.5±13.1)ng/ml and(11.9±16.0)ng/ml,and the preoperative IIEF-5 score was(15.0±4.0)and(14.8±4.2)points,respectively.Gleason scores were(7.2±0.8)points and(7.1±0.9)points,respectively,with no statistical significance(P>0.05).The clinical stages of cT,and cT,were 35 and 40 cases in the optimized group and 16 and 22 cases in the standard group,respectively.There were 5 and 1l cases of preoperative neoadjuvant therapy,respectively,with no statistical significance(P>0.05).The optimized RS-RARP is the blunt dissection of the denonvilliers fascia and forward to the apex of prostate,and retrograde release of the NVB.The operation time,intraoperative blood loss,drainage tube retention time,days of hospital stay,positive rate of pathological margin and incidence of complications were compared.The recovery of urinary continence was evaluated at 2 weeks after the catheter was removed,and the postoperative IIEF-5 score and PSA were followed up at 1 month after the surgery.Immediate urinary continence was defined as the use of 1 pad on the day of radical prostatectomy.Follow-up intervals were no more than 3 months.The log-rank test compared urinary incontinence rates between the two modalities.Results All 113 cases of surgery were completed,and median follow-up was 16 months.The operation time was(79.7±26.6)min and(149.8±40.1)min,and the intraoperative blood loss was(54.9±24.7)ml and(110.0±83.2)ml,respectively,and the

关 键 词：前列腺肿瘤 癌 机器人辅助 腹腔镜 保留Retzius间隙 前列腺切除术 

分 类 号：R737.25[医药卫生—肿瘤]