机器人辅助膀胱后入路根治性前列腺切除术的疗效分析

An evidence-based analysis comparing two approaches of robot-assisted laparoscopic radical prostatectomy:the standard technique and Retzius-sparing technique

目的比较机器人辅助前入路根治性前列腺切除术(前入路RARP)和机器人辅助膀胱后入路根治性前列腺切除术(后入路RARP)的术后结果和尿控恢复时间。方法回顾性分析浙江大学医学院附属邵逸夫医院2016年10月至2018年1月的92例进行RARP的低、中危局限性前列腺癌患者[前列腺特异性抗原(PSA)≤20μg/L,临床TNM分期≤cT2bN0M0,Gleason评分≤7]的临床资料,其中52例施行前入路RARP(前入路组),40例施行膀胱后入路筋膜内RARP(后入路组)。比较两组患者临床资料、围手术期指标(手术时间、术中出血、术后感染、术后漏尿、术后病理分期、术后Gleason评分)及手术效果(切缘阳性率和术后尿控恢复时间)。结果92例手术均顺利完成。前入路组手术时间(103±23)min,后入路组(130±26)min,差异有统计学意义(P<0.05)。前入路组术中出血(100±54)ml,术后感染率为5.8%(3/52),术后漏尿率为3.8%(2/52);后入路组则分别为(103±64)ml、5.0%(2/40)、2.5%(1/40),两组差异均无统计学意义(均P>0.05)。前入路组切缘阳性率为7.7%(4/52),后入路组切缘阳性率为12.5%(5/40),两组差异无统计学意义(P>0.05)。两组间即刻、1周、1个月、3个月尿控恢复率比较,后入路组均优于前入路组,差异均有统计学意义(均P>0.05);但6个月尿控恢复率差异无统计学意义(P>0.05)。结论膀胱后入路RARP术后可获得较为满意的肿瘤控制,术后早期尿控恢复较传统前入路RARP具有明显优势,是治疗局限性前列腺癌的可选术式。

Objective To compare the postoperative outcomes and urinary continence recovery time between standard robotic-assisted laparoscopic radical prostatectomy(RARP)and Retzius-sparing robotic-assisted laparoscopic radical prostatectomy(RsRARP).Methods A total of 92 patients with low to intermediate-risk prostate cancer who underwent RARP(n=52)and RsRARP(n=40)in Sir Run Run Shaw Hospital from October,2016 to January,2018 were retrospectively reviewed.Perioperative data(operative time,estimated blood loss,complications,postoperative staging,postoperative Gleason score)and surgical outcomes(rate of margin positive,urinary continence recovery time)of RARP and RsRARP group were comparatively analyzed.Results All 92 cases were successfully performed with robot.RARP group had a significantly shorter mean operative time when compared with that in RsRARP group((103±23)min vs(130±26)min,P<0.05).The two groups had comparable estimated blood loss((100±54)ml vs(103±64)ml,P>0.05),rate of postoperative infection(5.8%(3/52)vs 5.0%(2/40),P>0.05)and rate of postoperative urine leakage(3.8%(2/52)vs 2.5%(1/40),P>0.05).The two groups had a comparable rate of margin positive(7.7%(4/52)vs 12.5%(5/40),P>0.05).Compared with RsRARP group,the RARP group had a lower rate of urinary continence recovery immediately after the catheter removing at 1 week,1 month and 3 months after the operation(all P>0.05).The two group had a comparable rate of urinary continence recovery at 6 months after the operation(P>0.05).Conclusion The RsRARP technique has a good tumor control and obvious advantage of early urinary continence recovery compared with the standard RARP technique.RsRARP technique is safe and effective for the treatment of localized prostate cancer.