腹膜外途径机器人辅助腹腔镜根治性前列腺切除术:附20例报告

Extraperitoneal robot-assisted laparoscopic radical prostatectomy: report of 20 cases

目的探讨腹膜外途径机器人辅助腹腔镜根治性前列腺切除术的初步经验。方法前列腺腺癌患者20例,平均年龄65.6（50~75）岁。患者全部是在B超引导下经直肠前列腺穿刺活检病理证实为前列腺癌。Gleason评分≤6分7例,7分10例,8分2例,9分1例。影像学检查未见淋巴结及远处转移。病例均采用机器人辅助腹腔镜腹膜外顺行根治性前列腺切除术治疗。结果本组病例均顺利完成,未因任何原因更改术式。4例病例术后4周PSA〉0.2 ng/ml,提示术后肿瘤残留,先行雄激素去除治疗,择期再行外放射治疗。16例随访时间平均15.5（10~37）月。20例中机器人安装时间平均48.5（40~60）min,手术平均时间180（150~230）min,患者术中平均失血量298（80~800）ml,术后恢复进食时间平均1.7（1~3）d,留置尿管时间平均10.7（7~14）d,住院时间平均10.7（7~14）d。无手术并发症发生。术后病理Gleason评分≤6分6例,7分5例,≥8分9例。结论机器人辅助腹腔镜根治性前列腺切除术使腹腔镜易于被术者掌握,尤其在盆腔复杂手术方面的优点十分突出。

Objective To summarize our experience with extraperitoneal robot-assisted laparoscopic radical prostatectomy（RLRP）.Methods Twenty patients with confirmed prostate cancer by transrectal needle biopsy but no metastasis detected by radiographic examination underwent extraperitoneal RLRP,including 7 with Gleason score of less than 6,10 with a score of 7,2 with a score of 8,and 1 with a score of 9.Results The procedures were performed successfully in all the patients.In 4 cases,a postoperative PSA value of more than 0.2 ng/ml at 4 weeks suggested residual tumor,for which maximal androgen block therapy was administered before elective raditherapy.Sixteen patients were followed up for 10 to 37 months（mean 15.5 months）.In the 20 cases,the operation was completed in a mean of 180 min（range 150-230 min）,with the mean installation time of 48.5 min（range 40-60 min） and average blood loss of 298 ml（range 80-800 ml）.The mean postoperative eating time was 1.7 days（1 to 3 days）,the mean bladder catheter time was 10.7 days（7 to 14 days）,and the mean hospital stay was 10.7 days（range 7-14 days）.No postoperative complications occurred in these cases.Postoperative pathology showed a Gleason score no higher than 6 in 6 cases,7 in 5 cases,and no less than 8 in 9 cases.Conclusion The technique of extraperitoneal RLRP can be easily mastered by the surgeons and is especially advantageous for complicated pelvic operations.