达芬奇机器人在经尿道前列腺电切术后前列腺癌根治术的临床应用

doi:10.19558/j.cnki.10-1020/r.2019.03.007

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摘要目的探讨前列腺电切术后行机器人辅助腹腔镜前列腺癌根治术(RALRP)的可行性、安全性和疗效,总结初步经验。方法回顾性分析11例TURP术后确诊为前列腺癌并于2017年1月–2018年8月在上海长征医院接受RALRP治疗患者的临床资料。分析其围手术期指标、并发症、术后病理学结果、肿瘤控制情况及功能学恢复情况。结果所有RALRP手术均顺利完成,无中转开放手术病例及严重并发症。平均手术时间（132±30）min,平均出血量（212±102）mL,尿道吻合时间（19.6±4.7）min,术后尿管平均留置时间（10.0±2.5）d,腹腔引流管留置时间（4.0±1.7）d,保留神经血管束8例、膀胱颈口重建6例,所有病例均无直肠损伤及尿漏发生。术后所有病例前列腺切缘均为阴性,术后随访至2018年8月,未发现吻合口狭窄、肿瘤复发及远处转移。2例患者术后9个月仍有轻度尿失禁,其余患者排尿可控。术后性功能恢复率为54.5%。结论 RALRP治疗TURP术后前列腺癌安全有效,值得推广。

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关键词 ：经尿道前列腺电切术, 前列腺癌, 机器人辅助手术技术, 前列腺癌根治术

Abstract：Objective: To investigate the feasibility, safety and efficacy of the robotic-assisted laparoscopic radical prostatectomy (RALRP) in the patients with previous transurethral prostatectomy (TURP).Methods: The clinical data of 11 patients who underwent TURP and RALRP subsequently from January 2017 to August 2018 were retrospectively collected and analyzed. The complications in perioperative period, pathological results, tumor control and functional recovery in postoperative period were analyzed. Results: The operation procedures of all these patients were completed successfully. The mean duration of operation was (132 ±30) min, the mean blood loss was (212±102) mL, the mean duration for urethral anastomosis was (19.6±4.7) min, the mean urethral catheter detaining time was (10.0±2.5) days, and the postoperative peritoneal drainage duration was (4.0±1.7) days averagely. NVB retentions were performed in 8 cases and the bladder necks were reconstructed in 6 cases. No rectal injury or urinary leakage occurred in all cases. The surgical margins were negative in all cases. No anastomotic stricture, tumor recurrence and distant metastasis were found during the follow-up period. Two of these patients still suffered from mild urinary incontinence, and the urinary continence in rest patients were in good condition. The recovery rate of sexual function after operation was around 54.5%. Conclusion: The procedure of radical resection of prostate cancer after TURP is challenging. RALRP is effective and safe for the treatment of prostate cancer after TURP and worth being recommended.

Key words： transurethral resection of prostate prostate cancer robot-assisted surgery radical prostatectomy

收稿日期: 2018-11-14

ZTFLH:

R737.25

通讯作者: 阴雷,yin202@163.com

引用本文:

琚官群, 曹万里, 汪存洲, 林健海, 王林辉, 阴雷. 达芬奇机器人在经尿道前列腺电切术后前列腺癌根治术的临床应用[J]. 微创泌尿外科杂志, 2019, 8(3): 173-177.
JU Guanqun, CAO Wanli, WANG Cunzhou, LIN Jianhai, WANG Linhui, YIN Lei. Clinical application of robot-assisted laparoscopic prostatectomy in patients with previous transurethral prostatectomy. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2019, 8(3): 173-177.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1505.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2019/V8/I3/173

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