改良VIP术治疗局限性前列腺癌

Modified Vattikuti Institute prostatectomy for the treatment of localized prostate cancer

目的:初步探索改良Vattikuti研究所前列腺切除术(VIP)用于局限性前列腺癌的治疗效果。方法:回顾性分析2018年3月到2019年2月50例实施改良VIP和50例常规机器人辅助前列腺根治术(RARP)患者的资料,总结手术技巧和短期随访结果。结果:两组手术全部顺利完成,无中转开放。改良VIP组:手术时间(90.35±24.22)min,术中出血量(220.00±15.10)ml,术后住院天数(5.75±1.45)d,术后病理示切缘阳性率22.00%,随访1个月、6个月、1年恢复尿控率分别为76%、84%、96%。常规RARP组:手术时间(84.46±19.18)min,术中出血量(215.00±15.10)ml,术后住院天数(6.20±1.50)d,术后病理示切缘阳性率14.00%,随访1个月、6个月、1年恢复尿控率分别为22%、79%、94%。结论:改良VIP术式更大程度的保留了前列腺侧方及侧后方的筋膜组织,在不牺牲肿瘤控制的前提下促进术后尿控的恢复。

Objective:To investigate the effect of modified Vattikuti Institute prostatectomy(mVIP)in the treatment of localized PCa.Methods:This retrospective study included 50 cases of localized PCa treated by mVIP and another 50 by robot-assisted radical prostatectomy(RARP)from March 2018 to February 2019.We analyzed the baseline data,the surgical techniques used and the results of short-term follow-up.Results:All the operations were completed successfully without conversion to open surgery.The mVIP group,compared with the RARP,showed longer operation time([90.35±24.22]vs[84.46±19.18]min,P>0.05),more intraoperative blood loss([220.00±15.10]vs[215.00±15.10]ml,P>0.05),shorter postoperative hospital stay([5.75±1.45]vs[6.20±1.50]d,P>0.05),and higher rates of positive surgical margins(22.00%vs 14.00%,P>0.05)and urinary continence at 1 month(76%vs 22%,P<0.05),6 months(84%vs 79%,P>0.05)and 12 months after surgery(96%vs 94%,P>0.05).Conclusion:Modified VIP can better preserve the lateral and posterolateral prostatic fascial tissue in the treatment of localized PCa and therefore significantly promote the recovery of urinary continence after surgery.