经腹膜外途径行单孔机器人辅助腹腔镜前列腺癌根治术的临床应用(附36例报告)

Clinical application of robot assisted laparoscopic radical prostatectomy via single-port extraperitoneal approach:with a report of 36 cases

目的:总结经腹膜外途径行单孔机器人辅助腹腔镜前列腺根治术的临床经验。方法:2021年6月至12月共为36例前列腺癌患者经腹膜外入路行单孔机器人辅助腹腔镜前列腺癌根治术。Gleason评分均≤7分,cTNM分期T_(2c)期2例,余34例均为T_(2c)期以下。20例患者行标准的筋膜外切除技术(第1组),10例患者行常规筋膜内切除技术(第2组),6例采用最大保留周围结构的筋膜内切除技术(第3组)。结果:患者均顺利完成手术。第1组手术时间平均(75.5±15.5)min,第2组(105.6±18.8)min,第3组(85.6±16.8)min;术中出血量第1组平均(39.75±12.82)mL,第2组(82.5±12.08)mL,第3组(144.17±13.2)mL。术后6周复查总前列腺特异性抗原,均降至0.05 ng/mL以下。在尿控恢复方面,即刻尿控第1组为30%(6/20),第2组为70%(7/10),第3组为83.3%(5/6)。第2组、第3组在性功能恢复方面优于第1组。结论:经腹膜外入路行单孔机器人辅助前列腺癌根治术可成为中低危局限性前列腺癌的常规治疗方案,术后瘤控良好,尤其常规筋膜内切除技术与最大保留周围结构的技术,在术后早期即刻尿控、性功能恢复方面可取得较好效果。

Objective:To summarize the clinical experience of single-port extraperitoneal robot assisted laparoscopic radical prostatectomy.Methods:Patients with prostate cancer(n=36)underwent single-port robot assisted laparoscopic radical prostatectomy from Jun.2021 to Dec.2021.Gleason score was≤7.There were 2 patients with cTNM stage T_(2c),and the other 34 patients were below T_(2c).The operation was performed via extraperitoneal approach.20 patients underwent standard extra-fascial resection(Group 1),10 patients underwent conventional intra-fascial resection(Group 2),and intra-fascial resection with maximum preservation of the s urrounding structure was used in 6 patients(Group 3).Results:All patients successfully completed the operation.The average o peration time was(75.5±15.5)min in Group 1,(105.6±18.8)min in Group 2 and(85.6±16.8)min in Group 3.The average i ntraoperative bleeding volume was(39.75±12.82)mL in Group 1,(82.5±12.08)mL in Group 2 and(144.17±13.2)mL in Group 3.Total prostate specific antigen was rechecked 6 weeks after operation,and all patients decreased to less than 0.05 ng/mL.In terms of the recovery of urinary control,immediate urinary control was 30%(6/20)in Group 1,70%(7/10)in Group 2 and 83.3%(5/6)in Group 3.In terms of sexual function recovery,Group 2 and Group 3 were better than Group 1.Conclusions:Single-port e xtraperitoneal robot assisted radical prostatectomy can be a routine treatment for low and medium risk localized prostate cancer with good postoperative tumor control.In particular,conventional intra-fascial resection and maximum preservation of surrounding structure can achieve good results in terms of postoperative early immediate urinary control and sexual function recovery.