前入路保留Retzius间隙的Hood技术行机器人辅助腹腔镜前列腺癌根治术早期临床效果分析  

Early clinical outcomes of Retzius-sparing robot-assisted laparoscopic radical prostatectomy with Hood technique via anterior approach

作　　者：熊羊 李金 谢潇 汤志鹏 杨晗杰 XIONG Yang;LI Jin;XIE Xiao;TANG Zhipeng;YANG Hanjie(Department of Urology,Pingxiang People's Hospital,Pingxiang 337000,Jiangxi,China)

机构地区：[1]萍乡市人民医院泌尿外科,江西萍乡337000

出　　处：《中国现代手术学杂志》2024年第6期482-487,共6页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨采用前入路保留Retzius间隙的Hood技术行机器人辅助腹腔镜前列腺癌根治(RARP)术后早期尿控恢复效果。方法回顾性分析2023年4月至2024年5月我院采用Hood技术保留Retzius间隙行RARP手术的24例前列腺癌患者的临床资料。患者中位年龄68岁,BMI中位值23.55 kg/m2,前列腺体积中位值33.14 mL,术前前列腺特异性抗原(PSA)中位值17.26 ng/mL,临床分期:T1期3例,T2期14例,T3期7例。均采用Da Vinci Xi系统完成手术。观察并记录患者Gleason评分、手术时间、术中出血量、切缘情况、并发症以及即刻尿控等指标。结果本组24例患者均顺利完成手术,无中转开放病例,无转入ICU病例,无一例术后输血。本组手术时间为95~220 min,术中出血量60~210 mL。术后切缘阳性者4例,其中尖部切缘阳性3例,底部切缘阳性1例。术后第2~5天出现不全性肠梗阻4例,术后第3天出现淋巴漏1例。均获随访,随访时间3~7.5个月,中位时间4.8个月。所有病例未出现肠管损伤、吻合口漏、吻合口狭窄等,未出现Clavien-Dindo分级为Ⅲ级及以上并发症。21例患者拔除导尿管后恢复即刻尿控,即刻尿控恢复率为87.5%;3例患者拔除导尿管后出现尿失禁,其中1例经过3个月凯格尔训练后恢复尿控。结论Hood技术作为一种保留Retzius间隙的改良机器人前列腺癌根治技术,在不影响患者瘤控的前提下可实现绝大部分患者术后早期尿控,值得推广应用。Objective To explore the early recovery of urinary continence in patients undergoing Retzius-sparing robot-assisted laparoscopic radical prostatectomy(RARP)with Hood technique via anterior approach.Methods A retrospective analysis was conducted on 24 prostate cancer patients who underwent Retzius-sparing RARP with Hood technique via anterior approach in our hospital from April 2023 to May 2024.The median age was 68 years,with a median BMI of 23.55 kg/m2,prostate volume of 33.14 mL,and preoper-ative prostate specific antigen(PSA)level of 17.26 ng/mL.The Da Vinci Xi surgical system was utilized for all surgical interventions.Gleason score,operation time,intraoperative blood loss volume,surgical margin status,通信作者:熊羊,邮箱:[e-mail] complications,and immediate urinary continence were recorded and analyzed.Results The RARP opera-tions were successfully completed in all cases without conversion to open surgery,transfer to the intensive care unit(ICU),or need for postoperative blood transfusion.Operation time ranged from 95 to 220 minutes,with the blood loss of 60 to 210 mL.Positive margins were found in 4 cases,including 3 at the apex and 1 at the base.Postoperative complications included incomplete intestinal obstruction in 4 cases 2 to 5 days after surgery and lymphatic leakage in 1 case on day 3 after surgery.All cases were followed up for 3 to 7.5 months,with a median of 4.8 months.No complications,such as intestinal injury,anastomotic leakage,anastomotic stenosis,or Clavien-Dindo gradeⅢor higher,were observed.Immediate urinary continence was achieved in 21 cases after catheter removal,with an immediate urinary continence rate of 87.5%,while urinary incontinence occurred in 3 cases,with 1 case regaining urinary continence after 3 months of Kegel training.Conclusion The Hood technique,as a modified Retzius-sparing method for RARP,can ensure early recovery of postoperative urinary continence in majority of prostate cancer patients without compromising oncological outcomes,and is thus worthy o

关 键 词：前列腺癌 Hood技术 保留Retzius间隙 机器人辅助手术 腹腔镜根治性前列腺切除术 控尿功能 并发症 

分 类 号：R73[医药卫生—肿瘤]