倾向性评分队列研究两种不同入路机器人辅助根治性前列腺切除术的临床效果  

Propensity score-matched comparison of the clinical efficacy between two approaches of robot-assisted radical prostatectomy

作　　者：李振浩 朱照伟[1] 赵品 陶金[1] 李鹏[1] 范雅峰 刘云龙 于栓宝 张雪培[1] LI Zhenhao;ZHU Zhaowei;ZHAO Pin;TAO Jin;LI Peng;FAN Yafeng;LIU Yunong;YU Shuanbao;ZHANG Xuepei(Department of Urology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院泌尿外科,河南郑州450052

出　　处：《现代泌尿外科杂志》2024年第7期602-606,611,共6页Journal of Modern Urology

基　　金：河南省医学科技攻关计划省部共建重点项目(No.SBGJ202102140)。

摘　　要：目的 通过倾向性评分匹配法对比后入路-前入路-侧入路(PAL)联合入路与前入路(常规入路)机器人辅助根治性前列腺切除术(RARP)治疗前列腺癌(PCa)的临床效果及对术后尿控的影响。方法 回顾性分析郑州大学第一附属医院于2020年1月—2023年1月接受RARP治疗的145例PCa患者的临床资料,其中122例采用前入路(常规入路组),23例采用PAL联合入路(联合入路组),经过2∶1倾向性评分匹配后常规入路组46例,联合入路组23例,对匹配前后的不同入路RARP手术的PCa患者的围手术期结果均比较分析,包括手术时间、术中出血量、盆腔引流时间、术后住院时间、术中是否保留神经血管束(NVB)、是否缝扎背深静脉复合体(DVC)、是否重建膀胱颈以及术后拔尿管后即刻与术后1、3、6个月的尿控恢复率。结果 倾向性评分匹配后两组患者的基线资料、手术时间、术中出血量、盆腔引流时间、术后住院时间、术中是否保留NVB、是否重建膀胱颈差异均无统计学意义(P>0.05)。与常规入路组比较,联合入路组术中缝扎DVC的患者比例更少(100%vs.30.4%,P<0.001)。匹配前后联合入路组患者拔管后即刻与术后1、3、6个月尿控恢复率均优于常规入路组(P<0.05)。结论 与常规入路相比,PAL联合入路RARP治疗PCa同样安全有效,且术后早期尿控效果较好。Objective To compare the clinical efficacy and postoperative urinary control between robot-assisted radical prostatectomy(RARP)with posterior-anterior-lateral(PAL)approach and with anterior(conventional)approach using propensity score matching method.MethodsClinical data of 145 patients undergoing RARP in our hospital during Jan.2020 and Jan.2023 were retrospectively analyzed,including 122 patients in the conventional group and 23 in the PAL group.The patients were matched by 2:1 propensity score matching,including 46 cases in the conventional group and 23 in the PAL group.The perioperative outcomes were compared of prostate cancer(PCa)patients undergoing RARP surgery with different approaches before and after matching,including operation time,intraoperative blood loss,pelvic drainage time,hospitalization days,preservation of neurovascular bundles(NVB)during surgery,deep dorsal venous complex(DVC)suture,reconstruction of bladder neck,and postoperative urinary control recovery rate after extubation immediately,and 1,3,and 6 months after surgery.Results There were no significant differences in baseline data,operation time,bleeding volume,pelvic drainage time,hospitalization days,preservation of NVB,and reconstruction of bladder neck between the two groups(P>0.05).The PAL group used less DVC suture during surgery(30.4%vs.100%,P<0.001),but had better urinary control recovery rate immediately after extubation,1,3 and 6 months after surgery(P<0.05).Conclusion RARP with PAL approach is as safe and effective as the conventional approach,and has significant advantages in early postoperative urinary control.

关 键 词：机器人辅助 前列腺癌 前列腺切除术 后入路-前入路-侧入路 机器人辅助根治性前列腺切除术 早期尿控 倾向性评分匹配 

分 类 号：R737.25[医药卫生—肿瘤]