经会阴机器人辅助单孔腹腔镜根治性前列腺切除术的应用研究  

Application of perineal single-port robot-assisted radical prostatectomy

作　　者：徐力[1] 虞晨昊 安文进 朱世斌[1] 胡海义[1] 倪康欣[1] 李恭会[1] Xu Li;Yu Chenhao;An Wenjin;Zhu Shibin;Hu Haiyi;Ni Kangxin;Li Gonghui(Department of Lrology,Sir Run Run Shaw Hospital,Zhejiang Iniversity School of Medicine,Hangzhou 310016,China;Department of Urology,Jiangnan Hospital,Zhejiang Chinese Medical Unirersity,Hlangzhou.311201,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院泌尿外科,杭州310016 [2]浙江中医药大学附属江南医院泌尿外科,杭州311201

出　　处：《中华泌尿外科杂志》2024年第8期598-602,共5页Chinese Journal of Urology

摘　　要：目的探讨经会阴机器人辅助单孔腹腔镜根治性前列腺切除术的应用效果方法回顾性分析浙江大学医学院附属邵逸夫医院2019年7月至2022年7月由单术者开展的60例经会阴机器人辅助单孔腹腔镜根治性前列腺切除术患者的临床资料。年龄(65.9±7.6)岁,体质量指数(24.1±2.9)kg/m^(2)。18例既往共接受23次腹部手术。中位前列腺体积32.7(23.8,41.2)ml。中位基线前列腺特异性抗原(PSA)8.8(6.8,12.6)ng/ml。术前穿刺病理Cleason评分6分21例,7分35例,8分4例。临床分期T,期12例,T,期48例。患者取头低足高约15°的过度截石位。于两侧坐骨结节连线中点上方约2cm处做一3~5cm切口。切开会阴中心腱,牵开肛门外括约肌,沿直肠前平面向前游离至前列腺,置入一次性多通道腹腔镜手术入路系统并连接机器人手术器械。横向切开尿道直肠肌,打开狄氏筋膜后层,暴露并切断双侧精囊和输精管壶腹。近尿道处分离出前列腺包膜层面并沿该层面在前列腺两侧进行筋膜内钝性分离。在前列腺尖部与尿道连接处完整游离尿道后切断该处膜部尿道。游离并离断膀胱颈。切除前列腺和精囊,行膀胱尿道吻合。留置会阴部引流管。记录手术情况、围手术期并发症、术后尿控恢复情况(尿控恢复定义为每天使用尿垫≤1块)及肿瘤学控制结果。结果本研究60例手术均顺利完成,无中转开放或增加手术操作孔。中位总手术时间200.0(153.8,236.3)min,中位控制台操作时间107.5(90.0,150.0)min,中位术中出血量50.0(50.0,100.0)ml。切缘阳性率为8.3%(5/60)。术后1、3个月51例获得随访,尿控率分别为43.1%(22/51)、64.7%(33/51),PSA不可检测率分别为94.1%(48/51)、96.1%(49/51);术后6、12个月50例获得随访,尿控率分别为92.0%(46/50)、98.0%(49/50),PSA不可检测率分别为94.0%(47/50)、100.0%(50/50)。1例(1.7%)术后9个月出现生化复发。12例(20.0%)出现围手术期并发症,包括2例急性Objective To investigate the effect of perineal single-port robot-assisted radical prostatectomy.Methods A retrospective analysis was conducted on clinical data from 60 patients who underwent perineal single-port robot-assisted laparoscopic radical prostatectomy at our hospital between July 2019 and July 2022.The mean age of the patients was(65.9±7.6)years and the mean BMI was(24.1±2.9)kg/m^(2).The median(IQR)prostate volume was 32.7(23.8,41.2)ml,and the median(IQR)preoperative PSA value was 8.8(6.8,12.6)ng/ml.Preoperative pathology revealed a Gleason score of 6 in 21 patients,Cleason score of 7 in 35 patients and Cleason score of 8 in 4 patients.There were 12 patients clinically staged as T,and 48 patients as T2.A total of 18 patients underwent a total of 23 previous abdominopelvic surgeries.The patient is placed in an exaggerated lithotomy position with the head down and feet elevated approximately 15°.A 3-5 cm incision was made approximately 2 cm above on the midperineum between the bilateral ischial tuberosities.Next,the rectourethral muscle was divided,and the space anterior to the rectum was developed by blunt dissection.The levator ani muscles were separated to expose Denonvilliers'fascia.Then,the disposable multi-channel laparoscopic surgical access system is inserted with a surgical wound protector.Denonvilliers'fascia was incised transversely and the ampulla of the vas deferens,which were subsequently divided.Blunt separation is performed on both sides along the capsule of the prostate,and then,the vascular pedicles of the prostate are ligated.The membranous urethra was severed after complete urethral separation at the tip of the prostate at the urethral junction.The bladder neck was freed and dissected.The prostate and seminal vesicles were removed and a vesicourethral anastomosis is performed.A perineal drain were left in place.Preoperative and postoperative variables,complications,early urinary continence rate(Return of urinary continence status was defined as using no more than one safety pad per

关 键 词：前列腺肿瘤 局限性前列腺癌 机器人手术 单孔腹腔镜 经会阴根治性前列腺切除术 

分 类 号：R699[医药卫生—泌尿科学]