SUTURE技术在机器人根治性前列腺切除术中的应用

The application of SUTURE technique in robotic-assisted radical prostatectomy

目的总结篷内缝扎＋篷底复位加强（SUTURE）技术在机器人根治性前列腺切除术中的初步应用经验和术后初期随访结果，探讨该术式的安全性及有效性。方法2016年11月至2017年5月对连续64例行机器人腹腔镜根治性前列腺切除术患者术中应用SUTURE技术。患者年龄（66.6±1.6）岁，范围53～81岁。术前PSA 1.41～152.53 ng/ml，中位值PSA 15.29 ng/ml。术前肿瘤分期T1cN0M0～T3bN0M0。患者均行经直肠超声引导下前列腺穿刺活检明确诊断，穿刺针数6～15针。Gleason评分6～10分，平均7.3分。术前均行全身核素骨扫描、MR检查评估局部分期及骨转移情况。64例均行机器人腹腔镜根治性前列腺切除术，术中采用的SUTURE技术由篷内缝扎和篷底复位加强两部分组成。首先行篷内缝扎，在保留耻骨前列腺韧带完整性的前提下结扎控制背静脉复合体；然后行篷底复位加强，将耻骨前列腺韧带及篷底背静脉复合体断端与膀胱前壁缝合，重建悬韧带功能，恢复局部解剖结构。术后随访患者血清tPSA变化及尿控恢复情况。结果本组64例手术均顺利完成，未出现手术并发症。机器人手术时间66～150 min，平均95 min。术中出血量（106±15）ml，范围50～300 ml。术后2～4 d下床活动，14 d拔除导尿管。术后病理分期pT2aN0～pT3bN1，25例有包膜侵犯，12例有精囊侵犯，37例有神经侵犯。术后Gleason评分6～10分，平均7.2分。术后1个月血清tPSA 0.007～12.050 ng/ml，中位值PSA 0.047 ng/ml。49例术后随访1～6个月，术后1个月20例（40.8%）排尿可控；33例随访≥3个月的患者中25例（75.8%）排尿可控。结论在机器人腹腔镜根治性前列腺切除术中运用SUTURE技术可达到确切缝扎背静脉复合体、加强吻合口前壁及耻骨前列腺韧带重建的目的，术后尿控恢复满意，是一种安全、有效、系统化的背静脉复合体处理技术。

ObjectiveTo introduce the initial application experience of SUTURE （suture-under-tent and underside-reposition-enhancement） technique in robotic-assisted radical prostatectomy and discuss its safety and effectiveness.MethodsThe surgeon has performed 64 cases of Robotic-assisted radical prostatectomy between November 2016 to April 2017.The mean age was （66.6±1.6） years （53-81 years）; median PSA was 15.29 ng/ml（1.41-152.53 ng/ml）, tumor stage was T1cN0M0-T3bN0M0. The patients were diagnosed by ultrasound-guide prostate biopsy. The number of cores was 6-15, average Gleason score was 7.3 points （6-10 pionts）. ECT and MR were used to assess local stage and bone metastasis. The tPSA and urine recovery （urine pad test） was followed-up regularly. SUTURE technique consists of two parts, control the DVC effectively by retain the puboprostatic ligaments and puboprostatic ligaments reconstruction.ResultAll cases were successfully completed without complication, the average operation time was 95 min（66-150 min）; bleeding （106±15）ml（50-300 ml）. All the catheters were released 14 days after surgery. Postoperative pathological staging was pT2aN0-pT3bN1, 25 cases of capsule invasion, 12 cases with seminal vesicle invasion, 37 cases with nerve invasion. Average Gleason score was 7.2 points （6-10 points）. The median tPSA detected 4 weeks after surgery was 0.047 ng/ml（0.007-12.050 ng/ml）. The follow-up time was 1-6 months. The rate of urine control in 1 month and 3 month were 40.8% （20/49） and 75.8%（25/33）.ConclusionsBy using SUTURE technique we can control thedorsal vascular complexstrictly, and complete the puboprostatic ligaments reconstruction by stitch it to the anterior vesicourethral. The SUTRUE is a safe and effective systematic DVC controlling technique, and the early urinary control rate is satisfactory.