耻骨上经膀胱单孔机器人辅助前列腺根治性切除术的单中心中期疗效分析  

Single center mid-term result analysis of single-port suprapubic transvesical robotic assisted radical prostatectomy

作　　者：姜帅 熊鹰 戚宇 董宇 白奇 郭剑明 JIANG Shuai;XIONG Ying;QI Yu;DONG Yu;BAI Qi;GUO Jianming(Department of Urology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院泌尿外科,上海200032

出　　处：《上海医学》2023年第10期676-680,共5页Shanghai Medical Journal

基　　金：复旦大学附属中山医院临床研究专项基金(2018ZSLC32)。

摘　　要：目的本研究通过统计、分析行耻骨上经膀胱单孔机器人辅助前列腺根治性切除术(SPSV-RARP)的相对早期前列腺癌患者的临床效果及其中期随访情况,为进一步验证SPSV-RARP手术疗效优势提供临床证据支持。方法收集2019年1月—2020年12月在复旦大学附属中山医院泌尿外科行SPSV-RARP的31例前列腺癌患者资料,纳入SPSV-RARP组;并收集同期行传统机器人辅助腹腔镜前列腺根治性切除术的31例前列腺癌患者资料,纳入对照组。SPSV-RARP术中,术者建立单孔通道后,利用机器人辅助的腹腔镜系统通过这一单孔通道完成前列腺的根治性切除手术,并通过同一单孔通道移除标本。收集两组患者包括年龄,术前和术后前列腺特异性抗原(PSA)水平、前列腺体积、肿瘤TNM分期、病理Gleason’s评分、手术时长、术中出血量、术后拔除导尿管时间,以及术后尿控恢复情况(以尿垫用量数作为衡量标准)等指标。结果SPSV-RARP组手术均成功完成,无中转行开放手术病例,未有患者发生严重的术后并发症,患者的手术时长中位值为70 min(范围为50~100 min),术中出血量中位值为95 mL(范围为50~200 mL);术后病理分析显示该组所有患者的尿道切缘均为阴性,术后病理Gleason’s评分的中位值为7分(范围为6~9分)。对照组手术时长中位值为80 min(范围为50~120 min),术中出血量中位值为100 mL(范围为40~300 mL),尿道切缘均为阴性,术后病理Gleason’s评分中位值为7分(范围为6~9分)。SPSV-RARP组拔除导尿管的中位时间为7 d(范围为7~9 d),患者术后1、4、12周的每日尿垫用量的平均值分别为1.87、1.52、0.71块。对照组拔除导尿管中位时间为11 d(范围为9~15 d)。患者术后1、4、12周的每日尿垫使用量的平均值分别为2.68、2.26、1.35块。SPSV-RARP组患者术后6、12、24、36、48个月的PSA水平<0.1 ng/mL的比例分别为100%(31/31)、100%(31/31)、96.8%(30/31)、95.8%(23/24)和14/15Objective To assess the clinical outcomes and mid-term follow-up results of single-port suprapubic transvesical robotic assisted radical prostatectomy(SPSV-RARP)in patients with localized prostate cancer.Methods The clinical data of 31 consecutive patients with localized prostate cancer undergoing SPSV-RARP from January 2019 to December 2020 in Zhongshan Hospital,Fudan University were reviewed.Meanwhile,31 patients who underwent conventional robot-assisted radical prostatectomy were enrolled as controls.After establishing the surgical path,SPSV-RARP was performed using a robotic surgery system through a single suprapubic incision.Perioperative parameters,such as age,prostate-specific antigen(PSA)level,prostate volume,TNM staging,Gleason’s score,operation time,intraoperative blood loss,the time to catheter removal and postoperative urinary continence(the number of urine pads was used as a reference)were recorded.Results SPSV-RARP was successfully completed in all patients,there was no conversion to other approaches,and no severe postoperative complications occurred.The median operative time was 70 min(range,50-100 min)and median intraoperative blood loss was 95 mL(range,50-200 mL)in SPSV-RARP group.Negative surgical margins were achieved in all patients undergoing SPSV-RARP,and the median postoperative Gleason’s score was 7(range,6-9).In the control group,the median operative time was 80 min(range,50-120 min),median intraoperative blood loss was 100 mL(range,40-300 mL),median postoperative Gleason’s score was 7(range,6-9),and negative surgical margins were achieved in all patients.The median time to catheter removal after surgery was 7 d(range,7-9 d)in patients undergoing SPSV-RARP,and the mean pad usage per day was 1.87,1.52 and 0.71 at 1,4 and 12 weeks after surgery.In the control group,the median time to catheter removal after surgery was 11 d(range,9-15 d),and the mean pad usage per day was 2.68,2.26 and 1.35 at 1,4 and 12 weeks after surgery.The proportion of patients with PSA level<0.1 ng/mL was 100%(3

关 键 词：前列腺癌 单孔 机器人手术 经膀胱 尿控 

分 类 号：R737.25[医药卫生—肿瘤]