改良耻骨上入路(SAHZU法)机器人辅助前列腺癌根治术

Modified suprapubic approach(SAHZU)for robot-assisted laparoscopic radical prostatectomy

目的探讨改良耻骨上入路(SAHZU法)机器人辅助前列腺癌根治术治疗前列腺癌(RALP)的安全性及效果。方法回顾性分析2020年1月至2020年8月在我院接受SAHZURALP手术的19例前列腺癌患者的临床资料,包括:患者一般资料、围手术期指标、尿控、性功能和并发症等。结果19例患者均顺利完成手术,无术中并发症或中转开放手术,手术切缘均阴性。平均手术时间为(113±13)min,平均失血量为(47±12)ml。术后中位住院时间(IQR)为3(1~3)d,术后留置Foley导尿管的中位时间(IQR)为7(6~7)d,留置引流管的中位时间(IQR)为1(0~2)d。在早期功能方面,7例患者拔除尿管后可即刻尿控(0~1个垫片/d),术后随访至6个月时,有14例患者可完全尿控,8例患者勃起功能满意(IIEF评分≥18)。结论采用SAHZURALP治疗局限性前列腺癌在技术上是可行的。这项技术只需四个小切口,无需使用特伦德伦伯格(Trendelenburg)体位即可顺利完成手术,对肿瘤根治疗效好,术后尿控恢复满意,并发症少,但需要长期的随访数据,更多的患者以及临床随机对照研究来验证其疗效。

Objective To explore the safty and effect of the modified suprapubic robot-assisted laparoscopic radical prostatectomy(SAHZU-RALP)in treating prostate cancer.Methods All demographics,Perioperative data,complications,functional results and oncologic data of patients who underwent suprapubic SAHZU-RALP from January 2020 to August 2020 were recorded.ResultsNineteen consecutive patients underwent SAHZU-RALP.The mean operative time was(113±13)min.The mean blood loss was(47±12)ml.All cases were completed without intraoperative complications or conversions.The median(IQR)time of postoperative hospitalization was 3(1-3)days.The median(IQR)time with a Foley catheter after surgery was 7(6-7)days.The median(IQR)time with a drainage tube was 1(0-2)day.No patient had positive surgical margins and postoperative complications.On early functional outcomes,7 patients had instant urinary control(0-1 pads/day)when the Foley catheter were removed.Fourteen patients were recorded as full urinary control and 8 patients had erectile satisfaction for intercourse(IIEF score≥18)6 months after surgery.Conclusions SAHZU-RALP is technically feasible for patients with organ-confined prostate cancer.In our experience,potential advantages were founded including four small incisions,no Trendelenburg position and minor postoperative complications.But long-term follow-up data,more patients and clinical randomized controlled trials areneeded toverify its efficacy.