经尿道前列腺切除术后前列腺癌行达芬奇机器人辅助腹腔镜根治性前列腺切除术临床分析

Outcomes of robot-assisted laparoscopic prostatectomy in patients after previous transurethral prostatectomy

目的:分析达芬奇机器人辅助腹腔镜根治性前列腺切除术(RALRP)治疗经尿道前列腺切除术(TURP)后前列腺癌患者的特点和疗效。方法:回顾性分析我院2015年6月~2017年7月因TURP术后病理证实前列腺癌,并行RALRP病例共12例。年龄58~75岁,平均(67.3±4.9)岁。TURP与RALRP时间间隔3周~4个月,平均(2.6±1.0)个月。分析患者围手术期数据、术后病理和肿瘤控制、尿控情况。结果:12例患者手术顺利完成,无外科并发症。平均手术时间(125.0±26.0)min,术后腹腔引流时间平均(5.0±3.4)d,术后血红蛋白下降值(21.6±11.7)g/L。根治术后病理诊断:前列腺腺癌10例,肉瘤1例,未发现肿瘤1例。Gleason评分较电切标本升高者6例,切缘阳性1例。术后平均随访期9.8个月,1例患者术后6个月生化复发。尿控恢复时间平均为(2.7±1.3)个月。结论:TURP术后患者行前列腺根治手术难度和并发症可能增加,RALRP是值得推荐的手术方式。

Objective：To analyze the outcome of robot-assisted laparoscopic radical prostatectomy（RALRP）in patients after previous transurethral prostatectomy（TURP）.Method：Twelve post-TURP prostate cancer patients underwent RALRP during June 2015 to July 2017.In whom,the average age was（67.3±4.9）years old and the interval between TURP and RALRP was（2.6±1.0）months averagely.All perioperative,cancer-control and continence outcome were collected and analyzed.Result：Operations on all the patients were successful.The average operation duration was（125.0±26.0）min,postoperative drainage was sustained for（5.0±3.4）days averagely,and the average hemoglobulin decrease was（21.6±11.7）g/L.Postoperative pathological results showed1 case of prostate sarcoma,10 cases of prostate adenocarcinoma and 1case of cancer free.Gleason score increase was found in 6cases and positive surgical margin was detected in 1case.Average follow-up period was 9.8months and biochemical recurrence occurred in 1case.The average continence recovery time was（2.7±1.3）months.Conclusion：Compared with surgery-naive patients,more difficulties and complications will be demonstrated in post-TURP prostate cancer patients who undergo radical prostatectomy.RALRP might be a good choice for those patients due to its clearer sight,better operative space and flexible operation system.