保留Retzius间隙的机器人前列腺癌根治术在前列腺中叶突出患者中的应用

Application of Retzius-sparing robot assisted radical prostatectomy for patients with median lobe protrusion

目的报道首个应用保留Retzius间隙的机器人前列腺癌根治术(RS-RARP)治疗具有前列腺中叶突出(PML)的前列腺癌患者的病例系列研究,并评价RS-RARP在PML前列腺癌患者中的应用价值。方法收集2017年7月至2019年1月间于南京大学医学院附属鼓楼医院泌尿外科(南京大学泌尿外科研究所)接受同一外科医生行RS-RARP手术的有着明显PML的局限性前列腺癌患者的临床资料。所有患者行前列腺多参数核磁共振(mpMRI)检查。PML由T2加权的正中矢状面图像上进行测量。所有患者随访时间超过1个月。所有患者的病理切片由同一名泌尿外科病理医师进行判读。对患者基本情况、围手术期结果、切缘阳性率和早期尿控恢复进行研究。结果本研究共入组患者41例,中位年龄、中位体质量指数(BMI)、中位初始前列腺特异性抗原(PSA)水平、中位经直肠超声前列腺体积、中位PML、中位手术用时、中位估计手术出血量及中位住院时间分别为:70.0(67～75)岁, 24.0(21.7～26.3)kg/m^2, 8.4(5.5～15.4) ng/ml,40.8(32.4～47.4) ml,11.6(10.5～13.1)mm,155.0(140.0～185.0)min,200.0(125～300)ml,5.0(4.5～8.0)d。研究中,共有7例患者切缘阳性,总体切缘阳性率为17.1%(7/41)。前列腺基底切缘阳性率为0。在pT2期患者中,切缘阳性率为7.7%(2/26);在pT3期患者中,切缘阳性率为33.3%(5/15)。65.9%(27/41)的患者术后1个月内即恢复尿控, 51.2%(21/41)的患者术后即刻恢复尿控。结论对于PML患者,保留Retzius间隙的机器人辅助根治性前列腺癌切除术(RS-RARP)在控制切缘阳性率的前提下,能够改善患者术后早期尿控的恢复。

Objective To introduce the first case series receiving RS-RARP for prostate cancer with PML,and evaluate the potential advantage. Methods Consecutive clinical data of patients with significant PML who received RS-RARP by the same surgeon in our center between July 2017 and January 2019 was analyzed retrospectively.All patients underwent pelvic mpMRI which PML measured from.All pathologic images were confirmed by a genitourinary pathologist.The basic information,perioperative outcomes,rate of positive surgical margin and early urinary continence were analyzed. Results The median age,BMI,preoperative total PSA level,prostate volume,PML,operative time,estimated blood loss and length of hospital stay were 70.0(67-75)years,24.0(21.7-26.3)kg/m^2,8.4(5.5-15.4)ng/ml,40.8(32.4-47.4) ml,11.6 (10.5-13.1)mm,155.0(140.0-185.0)min,200.0(125-300)ml,5.0(4.5-8.0)days,respectively.The rate of PSM was 17.1%(7/41).None had positive base surgical margin.The rates of PSM were 7.7%(2/26) and 33.3%(5/15) in pT2 and pT3 patients,respectively.65.9%(27/41) of the patients were continent within 1 month,and 51.2%(21/41) patients were continent within 1 week. Conclusions RS-RARP can improve early urinary continence with a well positive surgical margin control in PML.