达芬奇机器人辅助腹腔镜前列腺癌根治术的治疗效果及对患者性功能及排尿功能的影响

Observation on effect of da Vinci robotic-assisted laparoscopic prostatectomy on sexual function and micturition function of patients with prostate cancer

目的探讨达芬奇机器人辅助腹腔镜下根治性前列腺切除术(RALP)治疗前列腺癌的效果,及对患者性功能及排尿功能的影响。方法回顾性分析2016年1月至2018年4月郑州大学第一附属医院泌尿外科由同一术者行RALP的480例患者的临床资料,按手术方法分为传统腹腔镜组(240例)和达芬奇机器人组(240例)。所有患者术后均进行2~24个月的随访,比较两组手术相关指标、性功能和排尿功能、并发症发生率、术后相关指标。结果达芬奇机器人组术中出血量[(130.26±21.45)ml]少于传统腹腔镜组[(265.02±23.32)ml],拔除尿管时间[(16.32±2.01)d]短于传统腹腔镜组[(19.68±2.33)d],差异有统计学意义(P<0.05)。治疗后,达芬奇机器人组国际勃起功能指数(IIEF-5)评分[(24.03±1.98)分]、最大尿道压[(43.18±2.96)cmH2O,1cmH2O=0.098kPa]、最大尿流量[(13.35±1.14)ml/s]均高于传统腹腔镜组[(21.24±2.01)分、(38.74±3.11)cmH2O、(10.21±1.02)ml/s],差异有统计学意义(P<0.05)。达芬奇机器人组并发症发生率为2.08%,勃起功能障碍率为6.67%,与传统腹腔镜组(7.50%、21.67%)比较,差异有统计学意义(P<0.05)。达芬奇机器人组切缘阳性率(25.00%)、生化复发率(23.33%)、术后辅助治疗率(44.17%)、术后住院时间[(14.09±3.26)d]、拔除引流管时间[(3.85±2.21)d]与传统腹腔镜组[20.00%、21.67%、47.50%、(15.65±5.03)d、(4.22±2.35)d]比较,差异未见统计学意义(P>0.05)。结论前列腺癌患者采用RALP治疗可减轻机体创伤性,降低并发症发生率,利于患者术后快速康复,同时可有效保留患者性生活能力及排尿功能。

Objective To investigate the therapeutic effect of da Vinci robotic-assisted laparoscopic prostatectomy(RALP)on prostate cancer and its influence on sexual function and micturition function.Methods The clinical data of 480 patients who underwent RALP by the same surgeon in the Department of Urology in the First Affiliated Hospital of Zhengzhou University from January 2016 to April 2018 were retrospectively analyzed.According to the surgical methods,they were divided into traditional laparoscopic group(240 cases)and da Vinci robotic group(240 cases).All patients were followed up for 2 to 24 months after surgery.The surgical related indicators,sexual function and micturition function,incidence of complication and postoperative related indicators were compared between the two groups.Results The intraoperative blood loss in da Vinci robotic group was(130.26±21.45)ml,which was less than the(265.02±23.32)ml of traditional laparoscopic group;and the extubation time of da Vinci robotic group was(16.32±2.01)d,which was significantly different from(19.68±2.33)d of traditional laparoscopic group(P<0.05).After treatment,international index of erectile function(IIEF-5)score,maximum urethral pressure,maximum urine flow of da Vinci robotic group were 24.03±1.98,(43.18±2.96)cmH2O(1 cmH2O=0.098 kPa),(13.35±1.14)ml/s,which were higher than 21.24±2.01,(38.74±3.11)cmH2O,(10.21±1.02)ml/s of traditional laparoscopic group,and the difference was statistically significant(P<0.05).The incidence of complications(2.08%)and erectile dysfunction rate(6.67%)in da Vinci robotic group were significantly different from those in traditional laparoscopic group(7.50%,21.67%),P<0.05.The positive rate of resection margin(25.00%),biochemical recurrence rate(23.33%),postoperative adjuvant treatment rate(44.17%),postoperative hospital stay(14.09±3.26)d,and extubation time(3.85±2.21)d in da Vinci robotic group were significantly different from these indexes in traditional laparoscopic group,which were 20.00%,21.67%,47.50%,(15.65±5.03)d,(4.22±2.35)d,respectively,P>0.05.Conclusions The use of RALP for patients with prostate cancer can reduce the trauma of the body,reduce the incidence of complications,facilitate the rapid recovery of patients after surgery,and effectively preserve the patient’s sexual function and micturition function.