目的:探讨前列腺中叶突出的前列腺癌患者行机器人辅助保留Retzius间隙前列腺根治术(Retzius-sparing robot-assisted radical prostatectomy,RsRARP)的安全性及可行性,分析围手术期结果。方法:回顾性分析2023年1月—2023年6月在解放军...目的:探讨前列腺中叶突出的前列腺癌患者行机器人辅助保留Retzius间隙前列腺根治术(Retzius-sparing robot-assisted radical prostatectomy,RsRARP)的安全性及可行性,分析围手术期结果。方法:回顾性分析2023年1月—2023年6月在解放军总医院第三医学中心行RsRARP的患者资料,通过术前影像学资料筛选出中叶突入膀胱≥2.0 cm的患者共12例,进行为期3个月的随访。患者中位年龄为68岁,中位体重指数(body mass index,BMI)为24.9 kg/m2。术前总前列腺特异性抗原(total prostate specific antigen,tPSA)中位数为9.0μg/L,游离PSA(free postate specific antigen,fPSA)中位数为1.375μg/L。穿刺总阳性针数中位数为2.5针,活检Gleason评分6分2例,8分2例,9分4例。临床TNM分期cT1c期2例,cT2a期8例,cT3b期2例。所有患者术前控尿均正常,国际勃起功能指数问卷表-5(International Index of Erectile Function5,IIEF-5)评分均小于7分。术后6周开始复查血清PSA,之后每3个月复查1次,记录术后1、2、3个月时控尿及勃起功能情况。结果:12例手术均顺利完成,无中转开放患者,无输血患者,无严重术中、术后并发症发生。所有患者均采用未保留勃起神经的筋膜外技术,2例术前活检提示9分的患者在术中进行了淋巴结清扫,中位手术时长(从建立气腹到缝合皮肤切口)为125.0 min,中位出血量为50 mL。术后病理示无包膜外及淋巴结转移,切缘阳性率为16.7%,pT2a期4例,pT2b期2例,pT2c期6例。Gleason评分3+4=7分2例,4+3=7分6例,4+5=9分4例。所有患者术后均成功拔除尿管,拔除时长中位数为14 d,术后3个月tPSA中位数为0.009μg/L,且所有患者均小于0.060μg/L,未观察到生化复发。所有患者术后3个月均无勃起功能。术后1个月尿控率为33.3%,2个月尿控率为66.7%,3个月尿控率为83.3%。结论:对于熟练掌握RsRARP的术者来说,RsRARP在治疗中叶突出的pT2期及以下前列腺癌患者时,对肿瘤控制和术后尿控相关解剖结构的保护效果较为理想,无严重并发症,出血量和手术时长较为可控。然而,仍需要进行大样本、长期随访研究以进一步探索和验证。展开更多
Objective:The present study was designed to evaluate the functional outcome of stapled transanal rectal resection(STARR)and to examine the relationship between the population density of the interstitial cells of Cajal...Objective:The present study was designed to evaluate the functional outcome of stapled transanal rectal resection(STARR)and to examine the relationship between the population density of the interstitial cells of Cajal(ICC)and the efficacy of the STARR operation in the management of obstructed defecation syndrome(ODS)patients.Methods:Full-thickness rectal samples were obtained from 50 ODS patients who underwent STARR.Samples were analysed using ICC immunohistochemistry.Clinical and functional parameters obtained with defecography and anorectal manometry were compared with 20 controls.Results:ICCs were significantly decreased in patients in the submucosal(SM),intramuscular(IM)andmyenteric(MY)regions when compared with the control group(P<0.05).The mean pre-operative Cleveland Constipation Score(CCS)was 24.264.1,whilst the CCS at 1,2,3,4 and 5 years post-operatively decreased significantly(P<0.05).At 3 post-operative years,58.3%(28/48)of the patients reported a favorable outcome(CCS10).On univariate analysis,the functional results were worse in those with pre-operative digitation(P=0.017),a decreased ICC-MY cell population(P=0.067),a higher resting anal canal pressure(P=0.039)and a higher rectal sensory threshold(P=0.073).Multivariate analysis showed the decreased ICC-MY cell population was an independent predictor for low unfavorable functional outcome(odds ratio=0.097,95%confidence interval:0.012–0.766).Conclusions:STARR achieved acceptable results at the cost of a slight deterioration over amore prolonged follow-up.Patients with a decreased ICC number in the rectal specimen showed an unfavorable functional outcome where pre-operative histological assessment of a full-thickness rectal samplemight predict for the functional outcome following STARR.展开更多
文摘目的:探讨前列腺中叶突出的前列腺癌患者行机器人辅助保留Retzius间隙前列腺根治术(Retzius-sparing robot-assisted radical prostatectomy,RsRARP)的安全性及可行性,分析围手术期结果。方法:回顾性分析2023年1月—2023年6月在解放军总医院第三医学中心行RsRARP的患者资料,通过术前影像学资料筛选出中叶突入膀胱≥2.0 cm的患者共12例,进行为期3个月的随访。患者中位年龄为68岁,中位体重指数(body mass index,BMI)为24.9 kg/m2。术前总前列腺特异性抗原(total prostate specific antigen,tPSA)中位数为9.0μg/L,游离PSA(free postate specific antigen,fPSA)中位数为1.375μg/L。穿刺总阳性针数中位数为2.5针,活检Gleason评分6分2例,8分2例,9分4例。临床TNM分期cT1c期2例,cT2a期8例,cT3b期2例。所有患者术前控尿均正常,国际勃起功能指数问卷表-5(International Index of Erectile Function5,IIEF-5)评分均小于7分。术后6周开始复查血清PSA,之后每3个月复查1次,记录术后1、2、3个月时控尿及勃起功能情况。结果:12例手术均顺利完成,无中转开放患者,无输血患者,无严重术中、术后并发症发生。所有患者均采用未保留勃起神经的筋膜外技术,2例术前活检提示9分的患者在术中进行了淋巴结清扫,中位手术时长(从建立气腹到缝合皮肤切口)为125.0 min,中位出血量为50 mL。术后病理示无包膜外及淋巴结转移,切缘阳性率为16.7%,pT2a期4例,pT2b期2例,pT2c期6例。Gleason评分3+4=7分2例,4+3=7分6例,4+5=9分4例。所有患者术后均成功拔除尿管,拔除时长中位数为14 d,术后3个月tPSA中位数为0.009μg/L,且所有患者均小于0.060μg/L,未观察到生化复发。所有患者术后3个月均无勃起功能。术后1个月尿控率为33.3%,2个月尿控率为66.7%,3个月尿控率为83.3%。结论:对于熟练掌握RsRARP的术者来说,RsRARP在治疗中叶突出的pT2期及以下前列腺癌患者时,对肿瘤控制和术后尿控相关解剖结构的保护效果较为理想,无严重并发症,出血量和手术时长较为可控。然而,仍需要进行大样本、长期随访研究以进一步探索和验证。
基金supported by the National Natural Science Foundation of China(No.81603628),Medical Scientific Research Foundation of Guangdong Province,China(No.A2015180)and Sun Yat-Sen University Clinical Research 5010 Program(No.2017017).
文摘Objective:The present study was designed to evaluate the functional outcome of stapled transanal rectal resection(STARR)and to examine the relationship between the population density of the interstitial cells of Cajal(ICC)and the efficacy of the STARR operation in the management of obstructed defecation syndrome(ODS)patients.Methods:Full-thickness rectal samples were obtained from 50 ODS patients who underwent STARR.Samples were analysed using ICC immunohistochemistry.Clinical and functional parameters obtained with defecography and anorectal manometry were compared with 20 controls.Results:ICCs were significantly decreased in patients in the submucosal(SM),intramuscular(IM)andmyenteric(MY)regions when compared with the control group(P<0.05).The mean pre-operative Cleveland Constipation Score(CCS)was 24.264.1,whilst the CCS at 1,2,3,4 and 5 years post-operatively decreased significantly(P<0.05).At 3 post-operative years,58.3%(28/48)of the patients reported a favorable outcome(CCS10).On univariate analysis,the functional results were worse in those with pre-operative digitation(P=0.017),a decreased ICC-MY cell population(P=0.067),a higher resting anal canal pressure(P=0.039)and a higher rectal sensory threshold(P=0.073).Multivariate analysis showed the decreased ICC-MY cell population was an independent predictor for low unfavorable functional outcome(odds ratio=0.097,95%confidence interval:0.012–0.766).Conclusions:STARR achieved acceptable results at the cost of a slight deterioration over amore prolonged follow-up.Patients with a decreased ICC number in the rectal specimen showed an unfavorable functional outcome where pre-operative histological assessment of a full-thickness rectal samplemight predict for the functional outcome following STARR.
