不依赖特殊装置单切口机器人前列腺根治术

doi:10.19558/j.cnki.10-1020/r.2021.02.006

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摘要 目的： 探讨无需使用特殊多通道入路装置实施单切口机器人辅助腹腔镜根治性前列腺切除术的可行性和有效性。方法： 不使用特殊多通道入路装置,而采用改良方法建立单切口腹膜外间隙实施机器人辅助腹腔镜根治性前列腺切除术。自2020年11月–2021年2月,共纳入51例均经病理证实的前列腺癌患者进行研究。患者平均68(58~80)岁;Gleason评分≤7分者40例,Gleason评分≥8分者11例;前列腺中位体积57.0(24.0,200.0)mL;临床分期<cT_3a者49例,cT_3a者2例;既往有手术史者21例。观察该方法的通道建立和机器对接时间、手术时间、出血量、保留尿管时间、肠道通气时间、并发症、病理结果、手术费用及随访结果。结果： 51例手术均按计划成功实施。通道建立和机器对接时间平均27(21~47)min;手术时间平均60.7(37~123)min;术中出血量平均77(42~228)mL;平均肠道通气时间1.0(0.5~3.0)d;平均保留尿管6.9(6~14)d;术后平均住院时间7.2(6~15)d。均无Ⅱ~V级并发症。术后：Gleason评分≤7分者38例、Gleason评分=8分者13例;病理分期<pT_3a者34例,≥pT_3a者17例;行闭孔淋巴结清扫者11例,均为阴性;切缘阳性9例,尿道残端送检阳性1例。23例实现即刻尿控,术后1个月31例尿控满意。术后4、8、12周PSA<0.2 μg/L的患者分别为28例、21例、10例。2例恢复勃起功能,1例恢复到术前水平,1例有勃起功能。手术费用平均降低6 000元（暨特殊装置费用）。结论： 不依赖特殊装置单切口机器人辅助腹腔镜根治性前列腺切除术,疗效满意,不受特殊耗材限制,较大幅度节约费用,具有良好的可行性和有效性。

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	聂钰
	陈正军
	周放
	任尚青
	范世达
	吕倩
	冯华林
	王强
	罗铖
	卫义
	王尧谦
	欧勇
	王东

关键词 ：机器人手术, 单切口, 前列腺根治术, 技术改良

Abstract：Objective： To assess the feasibility and validity of single-incision robot-assisted laparoscopic radical prostatectomy independent of special multi-channel port. Method： From November 2020 to February 2021, 51 consecutive patients with biopsy confirmed prostate cancer underwent extraperitoneal robot-assisted laparoscopic radical prostatectomy, independent of multichannel port. The median age was 68 （interquartile range [IQR], 58-80） years old; Gleason score was ≤7 in 40 cases, ≥8 in 11 cases, and the median prostate volume was 54 （IQR, 24.0-200.0 mL）; clinical stage was <cT_3a in 49 cases, cT_3a in 2 cases; 21 cases had a history of surgery. Data were collected and analyzed, including the time of the channel establishment and docking, operation time, blood loss, retention time of urinary catheter, restoration of intestinal function, complications, pathology, surgical cost and related follow-up results. Result： All the operations were successfully performed as planned. The median time of channel establishment and docking was 27 （IQR, 21-47） min; the median operation time was 60.7 （IQR, 37-123） min; the median intraoperative bleeding was 77 （IQR, 42-228） mL; the median time of intestinal exhaust was 1.0 （IQR, 0.5-3） d; the median time of catheter retention was 6.9 （IQR, 6-14） days; the median time of postoperative hospital stay was 7.2 （IQR, 6-15） days. No complication of level Ⅱ-V occurred. Postoperative Gleason score was ≤7 in 38 cases, and 8 in 13 cases; postoperative pathological staging was <pT_3a in 34 cases, ≥pT_3a in 17 cases. Obturator lymph node dissection was performed on 11 cases and all of them were negative; 9 cases had positive margin, and 1 case had positive urethral stump. Totally, 23 patients had immediate continence when urinary catheter was removed, and 31 patients had satisfactory continence within 1 month after surgery. PSA was <0.2 μg/L in 28 cases at 4th week, 21 cases at 8th week, and 10 cases at 12th week after surgery. The erectile function recovered in 2 cases, and returned to the preoperative level in one case, and one case had erectile function. The cost of surgery was reduced by an average of 6 000 Yuan RMB （the cost of special multi-channel port）. Conclusion： Single-incision robot-assisted laparoscopic radical prostatectomy independent of special multi-channel port is a feasible and safe surgical option. In our early experience, promising results and possible advantages were found, including no special multi-channel port, significant cost savings, and satisfactory curative effect, etc.

Key words： robotic surgery single incision radical prostatectomy technique improvement

收稿日期: 2021-03-10

基金资助:四川省科技厅项目（2017HH0106）

通讯作者: 王东,wangdong_robot@163.com

引用本文:

聂钰, 陈正军, 周放, 任尚青, 范世达, 吕倩, 冯华林, 王强, 罗铖, 卫义, 王尧谦, 欧勇, 王东. 不依赖特殊装置单切口机器人前列腺根治术[J]. 微创泌尿外科杂志, 2021, 10(2): 99-104.
NIE Yu, CHEN Zhengjun, ZHOU Fang, REN Shangqing, FAN Shida, LV Qian, FENG Hualin, WANG Qiang, LUO Cheng, WEI Yi, WANG Yaoqian, OU Yong, WANG Dong. Single-incision robotic radical prostatectomy independent of special multi-channel port. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2021, 10(2): 99-104.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1663.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2021/V10/I2/99

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