机器人辅助腹腔镜根治性前列腺切除术(附61例报告)

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摘要 目的:评估da Vinci S机器人辅助腹腔镜根治性前列腺切除术(RARP)的疗效和安全性。方法:回顾分析2009年7月~2012年8月应用RARP治疗61例临床资料,t-PSA水平为6.0~57.2 μg/L,平均(18.5±7.9)μg/L;Gleason评分6~9分,其中＜7分25例(40.9%),7分21例(34.4%),＞7分15例(24.5%)。肿瘤临床分期均为局限性前列腺癌。结果:61例均成功完成RARP术。术前机器人准备时间45~90 min,平均(62.7±12.4)min;手术时间120~300 min,平均(153.8±21.7)min;术中出血50~600 ml,平均(138.2±59.1)ml,2例(3.3%)术后输血400 ml。术后2~3 d下床活动,平均(2.2±0.6)d;术后住院5~8 d,平均(6.3±0.9)d;5~14 d拔除导尿管,平均(8.7±2.9)d。术后漏尿1例,漏尿于术后3 d停止。术后淋巴瘘5例,术后2~3周停止。术后病理切缘阳性6例(9.8%),精囊见癌侵犯4例(6.5%),闭孔淋巴结转移3例(4.9%)。术后1~12个月复查,t-PSA均＜0.2 μg/L,术后1~3个月有不同程度尿失禁10例(16.3%)。结论:RARP术安全、可靠,具有出血更少、恢复更快等优势,是前列腺癌手术治疗的首选方式。

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关键词 ：机器人, 前列腺癌, 机器人辅助腹腔镜根治性前列腺切除术

Abstract：Objective:To assess the efficiency and safety of robot-assisted laparoscopic radical prostectomy (RARP).Methods:We performed a retrospective chart review, evaluating 106 consecutive robot- assisted laparoscopic urological surgery with da Vinci S surgical system (da Vinci Intuitive Surgical Inc., Sunnyvale, CA, USA) from July 2009 to August 2012. Of the patients, Including 61 patients with local prostate cancer underwent robot-assisted radical prostatectomy (RARP). The clinical data of patients of RARP were analyzed.Results:All sixty-one patients received successful robot-assisted operation and encountered no technique events. The preoperative set-up time of the da Vinci S surgical system was 45-90 min, mean (62.7±12.4) min. The operating time ranged 120 to 300 min, mean (153.8±21.7) min. The estimated bloods loss was 50-600ml, mean (138.2±59.1) ml, and 2(3.3%) patients need transfusion. The patients were ambulant between 2nd and 3rd postoperative day, mean (2.2±0.6) d and discharged on postoperative day 5 to 8, mean (6.3±0.9) d. Foley catheter was removed on postoperative day 5 to 14, mean (8.7±2.9) d. Histopathology confirmed that 6 (9.8%) cases were positive surgical margin, seminal vesicle invasion in 4 (6.5%) and lymph node invasion in 3 (4.9%). The t-PSA was less than 0.2 μg/L during follow-up of one to twelve months and 10 (16.3%) cases were incontinence in postoperative month 3.Conclusions:Robot-assisted laparoscopic radical prostatectomy has the advantage of mini-invasiveness, less blood loss, rapid postoperative recovery, and it is a safe, reliable and should be taken as the first choice for radical prostatectomy. RARP offers better results in terms of the benefit of minimally invasive surgery. RARP is becoming the preferred approach for radical prostatectomy.

Key words： robotics prostate cancer robot-assisted laparoscopic radical prostatectomy

收稿日期: 2012-10-16

ZTFLH:

R737.2

通讯作者: 王国民,wang.guomin@zs-hospital.sh.cn

引用本文:

孙立安, 王国民, 徐志兵, 刘宇军, 郭剑明, 许明, 戎瑞明, 朱延军, 陈伟, 张建平, 姜帅, 徐磊, 武睿毅, 王杭, 朱同玉. 机器人辅助腹腔镜根治性前列腺切除术(附61例报告)[J]. 微创泌尿外科杂志, 2013, 2(1): 11-14.
Sun Li'an, Wang Guomin, Xu Zhibing, Liu Yujun, Guo Jianming, Xu Ming, Rong Ruiming, Zhu Yanjun, Chen Wei, Zhang Jianping, Jiang Shuai, Xu Lei, Wu Ruiyi, Wang Hang, Zhu Tongyu. Robot-Assisted Laparoscopic Radical Prostatectomy(Report of 61 cases). JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2013, 2(1): 11-14.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1092.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2013/V2/I1/11

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