保留近端尿道及无热前列腺切除策略在机器人辅助根治性前列腺切除术中的应用(附手术视频)  

Application of proximal urethral preservation and cautery-free technique in robot-assisted radical prostatectomy(with surgical video)

作　　者：成功[1] 承逸飞 梁玲辉 尚今伟 史杰嵘 董来 华立新[1] 宋宁宏[1] CHENG Gong;CHENG Yifei;LIANG Linghui;SHANG Jinwei;SHIJierong;DONG Lai;HUA Lixin;SONG Ninghong(Department of Urology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院泌尿外科,江苏南京210029

出　　处：《机器人外科学杂志（中英文）》2024年第4期505-510,共6页Chinese Journal of Robotic Surgery

基　　金：国家自然科学基金面上项目(82371620)。

摘　　要：目的:探讨机器人辅助下根治性前列腺切除术(RARP)中行保留近端尿道及无热切除策略对术后尿控恢复的临床价值。方法:回顾性分析2022年6月—2022年12月于南京医科大学第一附属医院行RARP的97例患者的临床资料,按是否进行保留近端尿道及无热前列腺切除将其分为试验组(n=39)和对照组(n=58)。试验组行保留近端尿道及无热前列腺切除,对照组未保留近端尿道并行电剪刀切除。所有患者随访6个月。比较两组患者尿控恢复情况,观察结局包括术后尿控时间、术后是否短期尿控及每日使用尿垫数量。结果:与对照组相比,试验组尿控恢复更快(P<0.001);试验组术后近期(1个月)尿控比例显著高于对照组(P<0.001)。试验组平均每日使用尿垫数显著少于对照组(P=0.001)。结论:在机器人辅助根治性前列腺切除术中采用保留近端尿道及无热切除技术,有助于患者术后尿路控制恢复和生活质量改善,值得临床推广。有必要进行更大样本量和更长随访期的进一步研究,以验证这些发现并确定该策略的长期效果。Objective:To evaluate the application value of proximal urethral preservation and cautery-free technique in robot-assisted radical prostatectomy(RARP)on postoperative continence recovery.Methods:A total of 97 patients who underwent RARP in the First Affiliated Hospital of Nanjing Medical University from June to December 2022 were included in this study.Among them,39 patients were assigned to the experimental group and received proximal urethral preservation and cautery-free technique,and 58 patients to the control group underwent RARP without preservation of proximal urethral.All patients were followed up for 6 months.Urinary continence recovery of patients in the two groups was compared.Time to postoperative continence,short-term continence,and pad use per day(PPD)of patients in the two groups were observed.Results:Compared with the control group,the experimental group recovered to continence faster after surgery(P<0.001).The proportion of patients with short-term continence recovery after surgery(<1 month)was significantly higher in the experimental group than that in the control group(P<0.001).The PPD in the experimental group was significantly fewer than that in the control group(P=0.001).Conclusion:The application of cautery-free technique and proximal urethral preservation in RARP showed promising results in terms of postoperative continence recovery and quality of life improvement,which is worthy of clinical promotion.Further studies with larger sample sizes and longer follow-up should be performed to validate these findings to determine the long-term effects of this strategy.

关 键 词：机器人辅助手术 前列腺癌 尿失禁 近端尿道 

分 类 号：R608[医药卫生—外科学] R737.25[医药卫生—临床医学]