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机器人前列腺癌根治术中“膀胱外中叶”的处理

The treatment of"extra-vesicle median lobe"in robotic radical prostatectomy
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摘要 目的报道一种特殊类型的前列腺增生的生长形态——膀胱外中叶的机器人处理。方法回顾2022年7月至2023年6月海军军医大学附属第一医院泌尿外科单术者实施的机器人前列腺癌根治术(RARP)共339例,其中238例保存有手术录像,重点回顾膀胱颈口离断及其后的前列腺背侧分离步骤,筛选出具有典型膀胱外中叶的患者共8例,结合患者术前多参数磁共振影像资料重新阅片复习,本文着重解析其中一例。结果膀胱外中叶常位于尿道侧后方,解剖部位与质地均接近对侧输精管及精囊,行机器人前列腺癌根治术时易误导术者进入错误的解剖层面,因手术层面修正导致手术时间延长,影响术者手术信心。此外术中钳夹“膀胱外中叶”组织导致的组织碎裂、残留等原因可造成术后“假性生化复发”,甚至“PSA持续状态”。结论如何在术前和术中判断“膀胱外中叶”的存在,并及时做出手术策略的调整是值得外科医师探讨的问题。 Objective To report the treatment of a peculiar morphology of prostatic hyperplasia nodule-the extra-vesicle median lobe during robot-assisted radical prostatectomy.Method Among the 339 cases of RARP performed by a single operator between July 2022 and June 2023,238 cases with preserved surgical videos were reviewed,focusing on the bladder neck dissection and its subsequent dorsal prostate detachment procedures,and a total of 8 patients with typical extravesical median lobes were screened out for reviewing in combination with the patient's preoperative multiparametric magnetic resonance imaging data.In this article,we would focus on the analysis of one of the cases.Results The extra-vesicle median lobe was usually located behind the urethra,and its anatomical location and texture were close to the contralateral vas deferens and seminal vesicles.During robot-assisted radical prostatectomy(RARP),it potentially misled the surgeon into the wrong anatomical plane.Due to the modification of the surgical plane,the operation time would probably be prolonged,which might impact the surgical determination of the surgeon.Conclusions How to predict the existence of"the extra-vesicle median lobe"before and during operation and make timely adjustment of surgical strategies is a problem worth exploring by surgeons.
作者 梅津熠 王燕 瞿旻 董振阳 周增辉 沈显琦 李嘉伦 高旭 Mei Jimyi;Wang Yan;Qu Min;Dong Zhenyang;Zhou Zenghui;Shen Xianqi;Li Jialun;Gao Xi(Department of Urology the First Afiliated Hospital of Naval Military Medical University,Shanghai 200433,China)
出处 《中华腔镜泌尿外科杂志(电子版)》 2023年第5期429-433,共5页 Chinese Journal of Endourology(Electronic Edition)
基金 国家重点研发计划项目子课题“亚健康***评价体系研究”(2020YFC2002704) 上海市科委“科技创新行动计划”优秀学术带头人计划项目(22XD1405000) 基于多中心专病数据库的前列腺癌精准治疗管理体系的建立(SHDC22021215)。
关键词 前列腺肿瘤 机器人前列腺癌根治术 膀胱外 中叶 多参数磁共振 Prostate cancer Robot-assisted radical prostatectomy Extra-vesicle Median lobe Multi-parametric MRI
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