四孔法腹膜外机器人辅助腹腔镜前列腺根治性切除术22例报道

Application of 4-hole extraperitoneal robot-assisted laparoscopic surgery in radical prostatectomy:a report of 22 cases

目的:探讨四孔法腹膜外机器人辅助腹腔镜根治性前列腺切除术的疗效及安全性。方法:回顾分析2019年8月~2019年12月四川省人民医院机器人微创中心采用四孔法行腹膜外机器人辅助腹腔镜下前列腺根治术22例患者的临床资料,平均年龄65.6(63~79)岁。患者术前全部活检证实为前列腺腺癌。其中Gleason评分≤6分3例,7分15例,8分3例,9分1例。MRI未见淋巴结及远处转移。结果:22例患者手术均顺利完成,术中未中转开腹及增加操作通道。建立腹膜外腔及机器臂安装时间平均45min(42~70min),手术时间平均120min(90~180min),术中出血量平均120ml(50~220ml),术后肛门排气平均时间22h(12~48h),引流管平均留置时间3d(2~7d),留置导尿管平均时间9d(6~14d),切口液化1例,引流管脱出1例。均无严重手术并发症发生。术后病理Gleason评分≤6分3例、7分15例、8分2例、9分2例。术后切缘阳性1例。术后1月复查PSA>0.2ng/ml,提示术后肿瘤残留,行雄激素内分泌治疗。术后拔除尿管后即刻控尿10例(45.4%),术后3个月内控尿恢复21例(95.4%),1例患者尿失禁。结论:四孔法腹膜外机器人辅助腹腔镜下行根治性前列腺切除术可以达到很好的控瘤效果,术后尿控及肠道功能恢复快。

Objective:To investigate the efficacy and safety of 4-hole extraperitoneal robot-assisted laparoscopic surgery in radical prostatectomy.Methods:The clinical data of 22 patients underwent extraperitoneal robot-assisted laparoscopic radical prostatectomy in Sichuan Provincial People’s Hospital from August 2019 to December 2019 were analyzed retrospectively.The average age was 65.6(63-79).Prostate adenocarcinoma was confirmed by the biopsies made before operation.Among them,3 cases with Gleason score≤6,15 cases=7,3 cases=8,1 case=9.No lymph node or distant metastasis found by MRI.All cases were treated with 4-hole extraperitoneal robot-assisted laparoscopic radical prostatectomy.Results:The 22 surgeries were all successfully completed without conversion to laparotomy or increasing of operation channels.The average installation time of extraperitoneal cavity and robot arm was 45 minutes(42-70min),the average operation time was 120 minutes(90-180min),the average intraoperative bleeding volume was 120 ml(50-220ml),the average postoperative anal exhaust time was 22 hours(12-48h),the average retention time of drainage tube was 3 days(2-7d),the average retention time of indwelling catheter was 9 days(6-14d).1 case was found incision liquefication.Drainage tube dislocation was found in 1 case.No serious complications occurred.Postoperative pathological Gleason score≤6 in 3 cases,7 in 15 cases,8 in 2 cases,9 in 2 cases.Positive margin was found in 1 case.Postoperative tumor residuals were found by reexamination on PSA>0.2ng/ml 1 month after operation and androgen-deprivation therapy(ADT)was performed.10 cases(45.4%)realized immediate urinary continence after catheter being removed,21 cases(95.4%)recovered urinary continence within 3 months and 1 case was found with incontinence.Conclusion:4-hole extraperitoneal robot-assisted laparoscopic radical prostatectomy has good tumor control effect and fast recovery of urine continence and intestinal function after operation.