保留Retzius间隙机器人根治性前列腺切除术与传统前入路机器人根治性前列腺切除术治疗前列腺癌伴中叶突出患者疗效比较  

Comparison of the efficacy of Retzius-sparing robot-assisted radical prostatectomy versus conventional anterior approach robot-assisted radical prostatectomy for the treatment of patients with prostate cancer with protruded median lobe

作　　者：李金桥 李卓然 徐俊楠 罗锦 唐金路 刘其威 贾玉琪 贾卓 杜松良 牛少曦 马鑫 王保军 LI Jinqiao;LI Zhuoran;XU Junnan;LUO Jin;TANG Jinlu;LIU Qiwei;JIA Yuqi;JIA Zhuo;DU Songliang;NIU Shaoxi;MA Xin;WANG Baojun(Department of Urology,Third Medical Center,Chinese PLA General Hospital,Beijing,100039,China;Medical School of Nankai University)

机构地区：[1]中国人民解放军总医院第三医学中心泌尿外科医学部,北京100039 [2]南开大学医学院

出　　处：《临床泌尿外科杂志》2025年第1期6-10,15,共6页Journal of Clinical Urology

基　　金：国家重点研发计划项目(No:2023YFC3606000)。

摘　　要：目的:比较分析保留Retzius间隙机器人根治性前列腺切除术(Retzius-sparing robot-assisted radical prostatectomy,Rs-RARP)与传统前入路机器人根治性前列腺切除术(conventional anterior approach robot-assisted radical prostatectomy,c-RARP)治疗前列腺癌伴前列腺中叶突出患者临床疗效。方法:回顾性分析2016年6月—2023年12月于解放军总医院第三医学中心泌尿外科医学部分别接受Rs-RARP和c-RARP治疗的245例前列腺伴中叶突出(术前MR中T2加权序列的正中矢状面测量膀胱颈到前列腺中叶突出部分的最大距离>0.5 cm)患者的临床资料,其中41例接受Rs-RARP治疗,204例接受c-RARP治疗。Rs-RARP术式在处理膀胱颈时利用膀胱自然悬吊并向尾侧牵张前列腺,在分离过程中暴露并最大化保留膀胱前列腺肌(vesicoprostatic muscle,VPM),于腺体和括约肌之间的间隙,充分游离后离断膀胱颈。c-RARP术式首先打开Retzius间隙,不常规结扎背深静脉复合体,依次处理膀胱颈、前列腺蒂和尿道;最后进行耻骨前列腺韧带的重建。通过倾向性评分1∶2匹配,纳入Rs-RARP组41例,c-RARP组82例。比较2组手术时间、术中出血量、术后病理切缘阳性率和即刻尿控等围手术期相关指标和术后1年之内的尿控结局。结果:2组手术时间、出血量、术后住院时间及术后切缘阳性率比较均差异无统计学意义。与c-RARP组比较,Rs-RARP组术后即刻尿控率(46.3%vs19.5%,P=0.002)、术后2个月尿控率(73.2%vs52.4%,P=0.027)、术后6个月尿控率(100.0%vs81.7%,P=0.007)以及术后12个月尿控率(100.0%vs84.1%,P=0.007)更好。结论:与c-RARP比较,Rs-RARP在治疗前列腺癌伴中叶突出患者同样安全、有效,同时具有更好的术后短期及远期尿控。Objective:To compare and analyze the clinical efficacy of Retzius-sparing robot-assisted radical prostatectomy(Rs-RARP)versus conventional anterior approach robot-assisted radical prostatectomy(c-RARP)for the treatment of patients with prostate cancer with protruded median lobe.Methods:A retrospective analysis was conducted on 245 patients with prostate cancer with a protruded median lobe(maximum distance from the bladder neck to the protruded median lobe of the prostate>0.5 cm as measured in the median sagittal plane of T2-weighted sequences in the preoperative MR)who underwent Rs-RARP and c-RARP at our center from June 2016 to December 2023,inclouding 41 cases of Rs-RARP and 204 cases of c-RARP.The Rs-RARP procedure utilized the natural suspension of the bladder and retraction of the prostate to the caudal side in the management of the bladder neck,exposing and maximizing the preservation of the vesicoprostatic muscle(VPM)during the detachment process in the gap between the gland and sphincter,and dissecting the bladder neck after adequate freeing.The c-RARP procedure utilized the traditional transperitoneal anterior approach(retropubic approach)pathway.By propensity score matching,41 cases in the Rs-RARP group and 82 cases in the c-RARP group were finally enrolled.The perioperative-related indicators such as operation time,estimated blood loss,positive surgical margin and immediate urinary control and urinary control outcomes within 1 year after operation were compared between the two groups.Results:There were no statistical differences between the two groups in terms of operative time,estimated blood loss,postoperative hospitalization time or positive surgical margin.Compared with the c-RARP group,the urinary control rates in the Rs-RARP group were higher in the immediate postoperative period(46.3%vs 19.5%,P=0.002),in the 2-month postoperative period(73.2%vs 52.4%,P=0.027),in the 6-month postoperative period(100.0%vs 81.7%,P=0.007)and 12 months postoperatively(100.0%vs 84.1%,P=0.007).Conclusion:Compared with

关 键 词：保留Retzius间隙机器人根治性前列腺切除术 前列腺癌 前列腺中叶突出 

分 类 号：R737.25[医药卫生—肿瘤]