机器人辅助腹腔镜根治性前列腺切除术130例

Robot-assisted laparoscopic radical prostatectomy of 130 cases

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月至2013年9月,复旦大学附属中山医院应用da Vinci S手术系统（da Vinci Intuitive Surgical Inc.,Sunnyvale,CA,USA.）完成RARP术130例的情况.年龄48～76岁,平均（67±6）岁;PSA水平为2.16～ 78.20 ng/ml,平均（26.05±8.41）ng/ml;Gleason评分6～10;肿瘤临床分期均为局限性前列腺癌.结果 130例均经腹腔途径,采用机器人3臂或4臂,5～6枚troc ar完成RARP,无机器人机械故障或其他原因导致的术式改变.术前机器人准备时间20 ～ 90 min,平均（48.5±15.4） min;手术时间90 ～ 300 min,平均（143.6±22.9） min;术中出血量50 ～ 600 ml,平均（158.2±59.6） ml,2例（1.5％）术后输血400ml.术后2～3d下床活动,平均（2.2±0.6）d;术后住院5～21d,平均（6.6±1.9）d;4～21d拔除导尿管,平均（6.1±2.0）d.术后主要并发症包括：漏尿6例（4.6％）,漏尿于术后3～15d停止.术后淋巴瘘8例（6.2％）,术后2～3周停止,未发现淋巴囊肿.术后下肢静脉栓塞、肺栓塞和附睾炎各1例,治疗后好转.术后病理切缘阳性12例（9.2％）,精囊见癌侵犯10例（7.7％）,闭孔淋巴结转移4例（3.1％）.术后1～12个月复查PSA均＜ 0.2 ng/ml,术后6个月和1年完全控尿率达86％和95％.结论RARP安全、可靠,具有出血更少、恢复更快等优势,是根治性前列腺切除术的首选方式.

Objective To assess the efficiency and safety of robot-assisted laparoscopic radical prostectomy （RARP）. Methods A retrospective chart review was perfomed, 130 patients radical prostatectomy （RARP） with da Vinci S surgical system （da Vinci Intuitive Surgical Inc., Sunnyvale, CA, USA ）from July 2009 to September 2013 localized prostate cancer underwent robot-assisted. The clinical data of patients underwent RARP were analyzed. The age range was 48 - 76years, mean （67 - 6）years. The PSA level range was 2.16 N 78.20ng/mL, mean （26.05 ± 8.41）ng/mL. Gleason score was 6 - 10. Tumor clinical stage of all patients are localized prostate cancer. Results All 130 patients received successful robot-assisted operation and encountered no technique events. A five or six ports transperitonealapproach using a 3 or 4-arm da Vinci S surgical system was used to perform RARP. The preoperative set up time of the da Vinci S surgical system was 20 - 90rain, mean （ 48.5 ± 15.4 ）rain. The operating time range was 90 - 300rain, mean （143.6 ± 22.9）rain. The estimated blood loss was 50-600ml, mean （ 158.2 ± 59.6 ）ml, and 2 （1.5%） 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 21, mean （ 6.6 ± 1.9 ）d. Foley catheter was removed on postoperative day 4 to 21, mean （ 6.1 ± 2.0 ）d. The main postoperative complications including： the urinary leak in six patients （4.6%）, prolonged lymphorrhea in eight patients （6.2%）, but not presented any form of lymphocele. Deep vein thrombosis, pulmonary embolism and epididymitis presented in one patient respectively. Histopathology confirmed in positive surgical margin 12 （9.2%） cases, seminal vesicle invasion in l0 （7.7%）cases and lymph node invasion in 4 （3.1%） cases. The PSA was less than 0.2 ng/ml during follow-up of one to twelve months postoperatively. The pad-free continence rate was 86% and 95% in postoperative month 6 and one year respectively. Conclusions Robot-assisted lapmoscopic radical prostatectomy has the advantage of mini-invasiveness, less blood loss, rapid postoperative recovery. It is safe,reliable and feasible. RARP should be taken as the first choice for radical prostatectomy.