改良RS-RARP+“三明治”法尿道重建技术对术后早期尿控的影响  

Effect of modified Retzius-sparing robot-assisted radical prostatectomy and"Sandwich"technique of total urethral reconstruction on the early postoperative urinary continence

作　　者：陈东 杨飞亚 王明帅 韩苏军 张世豪 郭博达 司占南 叶雄俊 张勇 邢念增 Chen Dong;Yang Feiya;Wang Mingshuai;Han Sujun;Zhang Shihao;Guo Boda;Si Zhannan;Ye Xiongjun;Zhang Yong;Xing Nianzeng(Department of Urology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心、国家肿瘤临床医学研究中心、中国医学科学院北京协和医学院肿瘤医院泌尿外科,北京100021

出　　处：《中华泌尿外科杂志》2024年第11期821-824,共4页Chinese Journal of Urology

基　　金：国家重点研发计划战略性科技创新合作重点专项(2022YFE0200800);中国医学科学院医学与健康创新工程(2022-12M-1-008)。

摘　　要：目的探讨改良保留Retzius间隙机器人辅助腹腔镜根治性前列腺切除术(RS-RARP)+“三明治”法尿道重建技术对术后早期尿控的影响。方法回顾性分析2021年10月至2023年11月中国医学科学院肿瘤医院同一术者采用改良RS-RARP+“三明治”法尿道重建技术治疗70例前列腺癌患者的临床资料。患者年龄(65.1±8.0)岁,体质量指数(25.6±3.1)kg/m^(2),前列腺体积(31.9±18.1)ml,初诊前列腺特异性抗原(PSA)(16.3±16.1)ng/ml。其中4例术前行内分泌治疗。11例为前列腺免穿刺患者;59例行前列腺穿刺活检,其中Gleason评分6.7、8、9、10分患者分别为10、23、14、10、2例。临床分期cT_(2)期48例,cT_(3)期22例。手术方法:采用改良RS-RARP,尿道和膀胱颈吻合采用“三明治”法尿道重建技术,即在尿道吻合口的前方及后方重建尿道支持结构。记录手术时间(机械臂操作时间)、术中出血量、术后引流管及导尿管留置时间、术后住院时间、病理分期及切缘情况、术后拔尿管后尿控情况。结果70例手术均顺利完成,无中转前入路标准根治手术和开放手术病例,术中无大出血或输尿管/直肠损伤等严重并发症发生。术后中位随访14(3,28)个月,无因手术并发症再次入院病例。手术时间(89.8±19.5)min,术中出血量(53.7±25.2)ml,术后引流管留置时间(6.7±1.8)d,术后住院时间(7.1±1.9)d,术后尿管留置时间(8.9±3.0)d。术后病理:4例术前行内分泌治疗患者未见癌;pT_(2)期42例,pT_(3)期22例,pT_(4)期2例。切缘阳性11例,总体阳性率16.7%(11/66),其中pT_(2)期切缘阳性4例[阳性率9.5%(4/42)],pT_(3)期切缘阳性5例[阳性率22.7%(5/22)]。50例患者拔除尿管实现即刻控尿,即刻控尿率为71.4%(50/70)。术后1个月控尿率为81.4%(57/70),术后3个月控尿率为90.0%(63/70)。术后1个月复查94.3%(66/70)的患者PSA<0.2ng/ml,术后3个月复查98.5%(69/70)的患者PSA<0.2ng/ml。结论改良RS-RARP+“三明治”法尿道�Objective To investigate the effect of modified Retzius-sparing robot-assisted radical prostatectomy(RS-RARP)and"Sandwich"technique of total urethral reconstruction on the early postoperative urinary continence.Methods The clinical data of 7O consecutive patients who underwent RS-RARP by the same operator at the Cancer Hospital of the Chinese Academy of Medical Sciences from October 2021 to November 2023 were retrospectively analyzed.The age was(65.1±8.0)years old,the body mass index(BMI)was(25.6±3.1)kg/m^(2),the prostate volume was(31.9±18.1)ml and the preoperative prostate specific antigen(PSA)was(16.3±16.1)ng/ml.Four patients treated with neoadjuvant hormonal therapy before radical prostatectomy.Eleven patients underwent radical prostatectomy without prostate biopsy,while the remaining 59 patients underwent prostate biopsy.There were 10,23,14,10 and 2 patients with Gleason scores of 6,7,8,9 and 10 respectively.There were 48 patients with clinical stage cT_(2) and 22 with cT_(3).The surgical method was RS-RARP and"Sandwich"technique of total urethral reconstruction.The operation time,intraoperative blood loss,postoperative drain tube preservation time,postoperative hospitalization time,pathological staging and positive margin rate,and recovery of urinary continence immediately after postoperative catheter removal were recorded.Results In this study,all 70 surgeries were successfully completed,with no cases converted to anterior approach radical surgery or open surgery,and no serious intraoperative complications such as post-shamus hemorrhage or ureteric/rectal injury.The median postoperative follow-up was 14(3,28)months,and there were no cases of readmission for surgical complications.The duration of surgery was(89.8±19.5)min,and the blood loss volume was(53.7±25.2)ml.The duration of drainage tube after surgery was(6.7±1.8)d,the duration of hospitalization after surgery was(7.1±1.9)d,and the duration of urinary catheter was(8.9±3.0)d.Immediate urinary continence was achieved in 50 cases when the cathet

关 键 词：前列腺肿瘤 癌 木根治性前列腺切除术 机器人 早期尿控 保留Retzius间隙 

分 类 号：R737.25[医药卫生—肿瘤]