经腹膜外耻骨上机器人辅助腹腔镜单纯前列腺切除术15例

Extraperitoneal suprapubic robot-assisted laparoscopic simple prostatectomy:a report of 15 cases

目的总结经腹膜外耻骨上机器人辅助腹腔镜单纯前列腺切除术(RASP)治疗良性前列腺增生的手术经验,探讨该术式的疗效及安全性。方法回顾性分析2015年4月至2018年11月接受经腹膜外耻骨上RASP的15例良性前列腺增生患者资料,记录手术时间、术中出血量、术后膀胱冲洗时间、术后引流时间、术后导尿管留置时间、术后住院时间及并发症发生情况,比较术前与术后国际前列腺症状评分(IPSS)、生命质量评分(QoL)、残余尿量(PVR)和最大尿流率(Qmax)的差异。结果15例手术均顺利完成。手术时间(控制台时间)为(92.0±28.3)min,术中出血量为(105.0±42.5)mL,没有患者需要输血治疗;术后膀胱冲洗时间为(2.2±0.5)d,术后引流时间为(1.8±0.6)d,术后导尿管留置时间为(5.7±1.2)d,术后住院时间为(4.1±1.3)d。术后3例发生Clavien-Dindo分级Ⅰ级并发症,1例发生Ⅱ级并发症。术后3个月随访,患者IPSS、QoL、PVR和Qmax均较术前改善(P均<0.01)。结论经腹膜外耻骨上RASP是一种安全有效的良性前列腺增生治疗方式。

Objective To summarize the surgical experience on extraperitoneal suprapubic robot-assisted laparoscopic simple prostatectomy(RASP)in the treatment of benign prostatic hyperplasia(BPH),and to discuss the efficacy and safety of this procedure.Methods A retrospective analysis was conducted on the clinical data of 15 patients with BPH undergoing extraperitoneal suprapubic RASP from Apr.2015 to Nov.2018.The operation time,estimated blood loss,postoperative bladder irrigation time,postoperative drainage time,postoperative catheterization time,postoperative hospital stay and complications were recorded.The postoperative international prostate symptom score(IPSS),quality of life(QoL),post-voiding residual volume(PVR)and maximal flow rate(Qmax)were compared with those before operation.Results The operation was successfully completed in all the 15 cases.The operation time(console time)averaged(92.0±28.3)min,estimated blood loss averaged(105.0±42.5)mL,and no patient needed blood transfusion.The postoperative bladder irrigation averaged(2.2±0.5)days,postoperative drainage averaged(1.8±0.6)days,postoperative catheterization averaged(5.7±1.2)days,and postoperative hospital stay averaged(4.1±1.3)days.Clavien-Dindo gradeⅠcomplications occurred in three cases,and gradeⅡcomplications occurred in one case.After 3 months of follow-up,the values of IPSS,QoL,PVR and Qmax were significantly improved in the patients(all P<0.01).Conclusion Extraperitoneal suprapubic RASP is a safe and effective surgical procedure for the treatment of BPH.