机器人腹腔镜根治性前列腺切除术2年经验总结

Two-year experience with robot-assisted laparoscopic radical prostatectomy

目的:评估机器人腹腔镜根治性前列腺切除术(rLRP)的围手术期结果及开展该手术2年来的100例经验。方法:2003年1月-2005年5月对100例患者实施了达.芬奇机器人手术系统的rLRP。所有患者经前列腺穿刺活组织病理检查确诊为前列腺癌,骨扫描无转移灶。由专人负责收集术后早期及功能康复结果的资料。结果:患者平均年龄(63.5±5.4)岁,Gleason评分为6分,治疗前PSA为(9.4±6.9)μg/L。机器人准备时间和手术时间分别为(24±14)min和(182±52)min;平均失血量(272±240)ml,输血率7%。留置导尿时间(8.4±4.1)天,住院时间(2.9±1.5)天。无围手术期死亡和中转开放手术患者。严重并发症包括需要再手术的膀胱尿道吻合口漏、脑血管意外、暂时性输尿管梗阻。轻微并发症包括轻度漏尿、膀胱颈部狭窄、尿路感染。平均随访时间(6.6±5.0)个月。术后标本病理分期pT2为55%,pT3为45%。切缘阳性率为12.7%。结论:机器人腹腔镜根治性前列腺切除术可以明显减少术中出血,降低输血率,缩短住院时间。机器人将复杂的盆腔腹腔镜手术变得简单易行,提高了手术的精细度和灵巧性。

Objective：To evaluate the initial 2-year experience with rLRP and reviewed the peri-operative outcome. Methods：One hundred patients underwent rLRP by a dedicated team using the da Vinci robotic surgical system from 1 February 2003 to 15 May 2005. All patients had histologically-confirmed adenocarcinoma on prostate biopsy and a negative bone scan. Peri-operative and early surgical outcome data were collected prospectively and functional recovery was assessed by an independent oncology nurse clinician. Results： The mean age at diagnosis was 63.5 ± 5.4 years. The median Gleason sum was 6 （range 4 to 9） and mean pretreatment PSA was 9.4 ±6.9 μg/L. The mean setup time and dissection time were 24 ± 14 minutes and 182 ± 52 minutes, respectively. The mean peri-operative blood loss was 272± 240 ml, and 7% of patients （ n = 7） required blood transfusion. The mean duration of bladder catheterization was 8.4±4.1 days, and mean hospital stay was 2.9± 1.5 days. There was rio peri-operative mortality or conversion to open radical prostatectomy. Major complications （4%） included urethrovesical leak requiring re-operation, post-operative cerebrovascular accident, and transient ureteric obstruction. Minor complications （7%） included minor urethrovesical leak, bladder neck stenosis, and urinary tract infection. Mean follow-up was 6.6±5.0 months. Pathological assessment showed pTz disease in 55% and pT3 in 45% of specimen. Margin positive rate was 12.7%. Conclusions：Robot-assisted LRP showed significantly low peri-operative blood loss, transfusion requirement and length of stay. The benefits of enhanced precision and dexterity for complex laparoscopic work in the pelvic cavity was apparent with the robot-assisted laparoscopic approach.