经腹膜外三孔法机器人辅助前列腺癌根治术的初步经验  

Preliminary experience with robot-assisted radical prostatectomy by extraperitoneal three-hole method

作　　者：谭云飞 宋宇 谢湖阳 管杨波[1] 蔡波[1] 马利民[1] TAN Yunfei;SONG Yu;XIE Huyang;GUAN Yangbo;CAI Bo;MA Limin(Department of Urology,Affiliated Hospital of Nantong University,Nantong 226001,China)

机构地区：[1]南通大学附属医院泌尿外科,江苏南通226001

出　　处：《现代泌尿外科杂志》2024年第3期244-247,共4页Journal of Modern Urology

摘　　要：目的介绍一种经本中心改良的手术技术--经腹膜外三孔法机器人辅助前列腺癌根治术(RARP)通道建立,探讨其操作方法、安全性及效果。方法回顾性分析2022年8月-2023年6月南通大学附属医院泌尿外科采用经腹膜外三孔法RARP的21例早、中期前列腺癌患者的临床资料,分享其手术通道建立的方法及技巧,同时观察手术相关指标如手术时间、术中出血量、术后并发症、引流管留置时间、术后住院时间及随访结果。结果21例患者的手术均由同一位医生顺利完成,术中未出现腹膜破损、增加辅助孔。建立腹膜外间隙和安装机械臂的时间为20.2(16.0~28.0)min,手术时间为107.0(60.0~161.0)min,术中出血量为52.8(31.0~121.0)mL,手术后第2天均恢复饮食,术后引流管留置时间为3.9(2.0~6.0)d,术后住院时间为4.9(3.0~7.0)d,术后均未发生严重并发症,术后尿管常规留置10 d,术后1月尿控满意的患者有20例(95.2%)。术后病理均为前列腺腺癌,切缘均阴性。国际泌尿病理协会(ISUP)预后分组:1组2例、2组6例、3组10例、4组2例、5组1例。结论经腹膜外三孔法RARP是一种安全可行的手术方式,具有腹膜外空间建立确切、器械之间碰撞少、手术费用低,术后肠道恢复快、切口美观、尿控恢复满意等优点。Objective To introduce a surgical technique modified by our center,the establishment of a robot-assisted radical prostatectomy(RARP)channel with extraperitoneal three-port method,and discuss its methods,skills,safety and efficacy.Methods Clinical data of 21 patients with early and intermediate prostate cancer treated with this surgery during Aug.2022 and Jun.2023 were retrospectively analyzed.Surgical time,intraoperative bleeding volume,postoperative complications,drainage tube retention time,postoperative hospital stay,and follow-up results were observed.Results All 21 cases of surgery were successfully completed by the same surgeon,without peritoneal rupture or addition of auxiliary holes.The time to establish the extraperitoneal gap and install robotic arm was 20.2(16.0-28.0)min,the operation time was 107.0(60.0-161.0)min,the amount of intraoperative bleeding was 52.8(31.0-121.0)mL.All patents resumed eating and drinking the next day after operation.The drainage tube indwelling time was 3.9(2.0-6.0)d,and the postoperative hospital stay was 4.9(3.0-7.0)d.No serious complications occurred.The urinary catheter was removed 10 days after operation.One month after operation,20 patients(95.2%)achieved satisfactory urinary control.The postoperative pathology was prostate adenocarcinoma in all cases,with negative margins,and the prognostic grouping of ISUP was 2 cases in group 1,6 cases in group 2,10 cases in group 3,2 cases in group 4,and 1 case in group 5.Conclusion RARP by extraperitoneal three-hole method is safe and feasible,with exact establishment of extraperitoneal space,few collisions between instruments,low surgical costs,fast postoperative intestinal recovery,aesthetic incision,and satisfactory recovery of urinary control.

关 键 词：前列腺癌 腹膜外途径 机器人辅助前列腺癌根治术 Trocar位置 三孔法 通道建立 

分 类 号：R737.25[医药卫生—肿瘤]