机器人辅助单孔腹腔镜根治性前列腺切除术在中高危患者中的应用

Application of single-port robot-assisted laparoscopic radical prostatectomy in medium or high-risk prostate cancer

目的:探讨机器人辅助单孔腹腔镜根治性前列腺切除术(Single-port Robot-assisted Radical Prostatectomy,spRARP)治疗中高危前列腺癌(Prostate Cancer,PCa)患者的临床应用价值。方法:回顾性分析哈尔滨医科大学附属第一医院2021年6月—2022年1月行spRARP手术患者的临床资料和围手术期指标,所有患者术前均评估为中高危PCa。结果:本研究共纳入8例患者,平均年龄为69.75(50~80)岁,平均体重指数(BMI)为24.75(17.96~28.34)kg/m^(2),平均PSA为43.67(8.58~100)ng/ml,Gleason评分平均为7(6~8)分。手术均顺利完成,未发生中转开腹或增加辅助通道。平均手术时间为219.38(130~290)min,平均出血量131.25(20~400)ml,术后均未使用阿片类镇痛药物,术后7d拔除导尿管且术后即刻尿控良好。切缘5例为阴性,3例为阳性,术后短期随访(1~6个月)均无漏尿,均无切口部位疼痛及不适感。结论:spRARP治疗中高危PCa安全、可行,该术式具有切口小、术后恢复快、疼痛小等特点,但其远期疗效仍待进一步验证。

Objective:To investigate the clinical application of single-port robot-assisted radical prostatectomy(spRARP)in patients with medium or high-risk prostate cancer(PCa).Methods:Clinical data and perioperative parameters of patients under spRARP for medium or high-risk PCa in the First Affiliated Hospital of Harbin Medical University from June 2021 to January 2022 were collected and analyzed retrospectively.Results:8 patients were selected in this study,with the average age of 69.75(50-80)years and mean body mass index(BMI)of 24.75(17.96-28.34)kg/m^(2).The average PSA was 43.67(8.58-100)ng/ml,and the average Gleason score was 7(6-8).All surgeries were successfully completed without conversion to laparotomy or adding auxiliary channels.The mean operative time was 219.38(130-290)min,with an average blood loss of 131.25(20-400)ml.No opiate analgesics were used after operation.The catheter was removed 7 days after operation and immediate postoperative urinary continence was satisfied.Negative margins were found in 5 cases and positive margins in 3 cases.There was no leakage of urine during the short-term followup(1-6 months)after operation,and no pain or discomfort occurred at the incision site.Conclusion:spRARP is safe and feasible in treating moderate or high risk PCa,but further studies should be done to confirm its long-term efficacy.