Hood技术对机器人辅助单孔腹腔镜根治性前列腺切除术后尿控的影响

Effect of Hood's technique on urinary continence after single-port robot-assisted laparoscopic radical prostatectomy

目的评估Hood技术对机器人辅助单孔腹腔镜根治性前列腺切除术(spRARP)后患者尿控的影响。方法回顾性分析2021年6月至2023年10月哈尔滨医科大学附属第一医院由单一术者行spRARP的53例患者的临床资料,其中25例采用Hood技术(为spRARP+Hood组),28例仅接受spRARP而未采用Hood技术(spRARP组)。spRARP+Hood组与spRARP组患者年龄[(70.28±5.98)岁与(60.89±6.86)岁]、体质量指数[(24.64±2.85)kg/m^(2)与(24.59±3.17)kg/m^(2)]、前列腺质量[70.00(40.69,102.25)g与73.50(49.13,94.50)g]、总前列腺特异性抗原[8.62(4.56,15.26)ng/ml与12.68(6.99,19.24)ng/ml]、Gleason评分[8(7,8)分与8(7,8)分]、年龄校正Charlson合并症指数(aCCI)[4(3,5)分与3(3,4)分]、临床分期(T_(2a)/T_(2b)/T_(2c):6/10/9例与5/7/16例)的差异均无统计学意义(P>0.05)。spRARP+Hood组术中完整保留逼尿肌围裙、肌腱弓、耻骨前列腺韧带和背侧血管复合体;spRARP组术中完全切除逼尿肌围裙、肌腱弓、耻骨前列腺韧带和背侧血管复合体。比较两组术中相关指标、术后切缘阳性率、拔除尿管后即刻尿控恢复率,以及术后1、3、6个月的尿控恢复率。结果53例手术均顺利完成。spRARP+Hood组与spRARP组切口长度[4.0(3.5,4.0)cm与4.0(4.0,4.0)cm]、术中出血量[50(40,100)ml与100(50,100)ml]、术中输血率[4.0%(1/25)与17.8%(5/28)]差异均无统计学意义(P>0.05),手术时间[205.0(167.5,240.0)min与242.5(185.0,300.0)min]差异有统计学意义(P<0.05)。spRARP+Hood组与spRARP组胃肠道功能恢复时间[1.0(1.0,1.5)d与1.0(1.0,2.0)d]、术后前3d引流总量[150.00(72.50,261.00)ml与230.00(115.00,417.50)ml]、引流管留置时间[5.0(4.0,5.0)d与5.0(4.0,6.8)d]、术后住院时间[5.0(4.0,7.5)d与5.0(3.3,7.8)d]、切缘阳性率[4.0%(1/25)与3.6%(1/28)]差异均无统计学意义(P>0.05)。两组术后Clavien-Dindo并发症分级均为Ⅰ级。spRARP+Hood组与spRARP组患者拔除尿管后即刻尿控恢复率[56.0%(14/25)与7.1%(2/28)]及术后1个月尿控恢复率[76.0%(19/25)与28.5%(8/28)]差异均有统计学意义(P<0.05);两组术后3个月尿控恢复率[80.0%(20/25)与67.8%(19/28)]、术后6个月尿控恢复率[88.0%(22/25)与96.4%(27/28)]及术后6个月生化复发率[4.0%(1/25)与3.6%(1/28)]差异均无统计学意义(P>0.05)。结论SspRARP+Hood治疗局限性前列腺癌的肿瘤控制效果与spRARP相当,但spRARP+Hood拔除尿管后即刻尿控和术后1个月尿控效果更好。

Objective To assess the effect of Hood's technique on urinary continence in patients undergoing single-port robot-assisted radical prostatectomy(spRARP).Methods The clinical data of 53 patients who underwent spRARP performed by a single surgeon in the First Affiliated Hospital of Harbin Medical University from June 2021 to October 2023 were retrospectively analyzed.There were 25 patients in the spRARP+Hood group and 28 patients in the spRARP group.There were no statistically significant differences between the spRARP+Hood group and the spRARP group in terms of patients'age[(70.28±5.98)years vs.(60.89±6.86)years old],body mass index[(24.64±2.85)kg/m^(2)vs.(24.59±3.17)kg/m^(2)],prostate weight[70.00(40.69,102.25)g vs.73.50(49.13,94.50)g],total prostate specific antigen[8.62(4.56,15.26)ng/ml vs.12.68(6.99,19.24)ng/ml],Gleason score[8(7,8)vs.8(7,8)],age-adjusted Charlson comorbidity index(aCCI)[4(3,5)vs.3(3,4)],and clinical stage[T_(2a)/T_(2b)/T_(2c):6/10/9 cases vs.5/7/16 cases](P>0.05).In the SpRARP+Hood group,the detrusor apron,tendon arch,pubic prostatic ligament,and dorsal vascular complex were completely preserved during the operation.In contrast,this was not the case for spRARP.Additionally,the incision size,bleeding volume,intraoperative blood transfusion volume,operation time,gastrointestinal function recovery time,total amount of drainage in the first three postoperative days,retention time of the drainage tube,postoperative hospitalization time,positive incision margins,recovery rate of urinary continence immediately after removal of the urinary catheter,and the recovery rate of urinary continence at 1,3,and 6 months postoperatively were compared between the two groups.Results All 53 surgeries were successfully completed.The differences in incision length[4.0(3.5,4.0)cm vs.4.0(4.0,4.0)cm],intraoperative bleeding[50(40,100)ml vs.100(50,100)ml],and intraoperative transfusion rate[4.0%(1/25)vs.17.8%(5/28)]were not statistically significant between the spRARP+Hood group and the spRARP group(P>0.05),and the difference in operative time[205.0(167.5,240.0)min vs.242.5(185.0,300.0)min]was statistically significant(P<0.05).The recovery time of gastrointestinal function in the spRARP+Hood group vs.the spRARP group[1.0(1.0,1.5)d vs.1.0(1.0,2.0)d],total amount of drainage in the first 3 d postoperatively[150.00(72.50,261.00)ml vs.230.00(115.00,417.50)ml],duration of drain retention[5.0(4.0,5.0)d vs.5.0(4.0,6.8)d],postoperative hospital stay[5.0(4.0,7.5)d vs.5.0(3.3,7.8)d],and margin positivity rate[4.0%(1/25)vs.3.6%(1/28)] were not statistically significant(P>0.05).The postoperative Clavien-Dindo complication classification was grade Ⅰ in both groups.The differences between the spRARP+Hood group and the spRARP group in the rates of recovery of urinary continence immediately after the urinary catheter removal[56.0%(14/25)vs.7.1%(2/28)]and one month after surgery[76.0%(19/25)vs.28.5%(8/28)] were statistically significant(P<0.05).The differences in the rates of recovery of urinary continence at 3 months after surgery[80.0%(20/25)vs.67.8%(19/28)],at 6 months after surgery[88.0%(22/25)vs.96.4%(27/28)],and biochemical recurrence at 6 months after surgery[4.0%(1/25)vs.3.6%(1/28)]were not statistically significant(P>0.05).Conclusions The outcomes of spRARP+Hood in the treatment of localized prostate cancer were comparable to those of spRARP.However,spRARP+Hood has better urinary continence immediately after removal of the urinary catheter and 1 month postoperatively.