机器人辅助经膀胱颈纵切口根治性前列腺切除术治疗早期前列腺癌的疗效分析

The transvesical approach technique for robot-assisted radical prostatectomy for early stage prostate cancer

目的探讨机器人辅助经膀胱颈纵切口根治性前列腺切除术的疗效及安全性。方法回顾性分析2017年6月至2020年5月浙江省人民医院收治的41例行机器人辅助经膀胱颈纵切口根治性前列腺切除术患者的临床资料。年龄平均62.5(51~69)岁,前列腺体积平均36.3(22.0~57.8)ml,术前前列腺特异性抗原(PSA)平均7.3(3.7~12.3)ng/ml,术前Gleason评分均≤7分,临床分期T_(2a)~T2b期。患者由前列腺穿刺活检(26例)或前列腺剜除术后(15例)病理标本确诊为前列腺癌,均未接受内分泌治疗。均采用机器人辅助经膀胱颈纵切口根治性前列腺切除术,术中辨认及保留膀胱颈部,采用纵向小切口打开膀胱,筋膜内切除前列腺,充分保留耻骨前列腺韧带及阴部动脉等结构的完整性,达到解剖结构的完全复位。记录围手术期指标,随访患者尿控及肿瘤控制情况。结果本组41例手术均顺利完成,无中转开放手术。手术时间平均111.3(105~131)min,术中出血量平均95.5(50~220)ml,术后住院时间平均5.2(3~8)d,术后导尿管留置时间平均6.3(5~7)d。无严重手术并发症。术后病理诊断:Gleason评分6分25例,7分12例,8分2例;2例前列腺剜除术后患者未见前列腺癌组织。术后TNM分期T_(2a)~T_(2c)期。术后2例前列腺尖部切缘阳性。术后随访6~24个月,35例(85.4%)获得即时尿控,4例术后1周无漏尿,2例术后1个月无漏尿;术后6个月41例均获得良好尿控。41例术后肿瘤控制良好,均无肿瘤生化复发(tPSA<0.2 ng/ml)。结论机器人辅助经膀胱颈纵切口根治性前列腺切除术后并发症少,切缘阳性率较低,术后早期尿控恢复好,也适用于前列腺剜除术后的前列腺癌患者。

Objective To investigate the feasibility and safety of the transvesical approach of robot-assisted radical prostatectomy.Methods From June 2017 to May 2020,41 patients underwent transvesical approach of robot-assisted radical prostatectomy.The patients’mean age was 62.5(51-69)years.The mean prostate volume was 36.3(22.0-57.8)ml.The mean preoperative PSA value was 7.3(3.7-12.3)ng/ml.All preoperative Gleason score was less than or equal to 7 points and preoperative TNM stage ranged from T_(2a) to T2b.All patients were diagnosed by prostate biopsy before surgery or pathological diagnosis after prostate enucleation.Robot-assisted radical prostatectomy through the longitudinal incision of the bladder neck was used.It was easy to identify and preserve the bladder neck during the operation.The bladder was opened with a small longitudinal incision,and the prostate was removed intrafascial.The pubic prostatic ligament and pudendal artery were fully preserved to achieve complete reduction of the anatomical structure.Results All the operations were completed by robot-assisted radical prostatectomy with no transition to open surgery.The mean surgery time was 111.3(105-131)min.The mean estimated blood loss was 95.5(50-220)ml.The mean postoperative hospital stay was 5.2(3-8)d.The time of postoperative catheter removal was 6.3(5-7)d.After 6 to 24 months of follow-up,35 patients(85.4%,35/41)received immediate recovery of continence,4 patients had no urine leakage after 1 week,and 2 patients had no urine leakage after 1 month.All patients had regained continence 6-month postoperatively.No tumor biochemical recurrence(tPSA<0.2 ng/ml).Conclusions The transvesical approach of robot-assisted radical prostatectomy was a safe and effective surgical technique,which was beneficial in early continence recovery,and also suitable for prostate cancer patients after prostate enucleation.