摘要
目的探讨机器人辅助腹腔镜下根治性前列腺切除术（robotic-assisted laparoscopic radical prostatectomy，RALP）性功能保留的关键手术技巧及手术疗效。方法回顾性分析2016年2月至2016年5月我院30例行RALP患者的临床资料。年龄48～82岁，平均67．3岁。患者术前PSA7．6—53．4ng／ml，平均21．1ng／ml。术前Gleason评分：6分7例，7分16例，8分6例，9分1例。术前勃起功能评分（IIEF-5）：0～10分3例，11～15分4例，16～20分17例，21～25分6例。RALP保留性功能的手术技巧包括：缝扎背深静脉复合体（dorsal vein complex，DVC）技巧、“隧道法”结扎DVC技巧、“逆行法”保留神经血管束技巧、“顺行法”保留神经血管束技巧以及引流管放置技巧。结果30例均顺利完成手术，无中转开放手术。手术时间98—240min，平均150．7min。出血量50—550ml，平均165．7ml。所有患者术中均未输血治疗。术后引流管留置时间2≈20d，平均5．1d；术后患者肠道恢复时间2—5d，平均2．7d；术后住院时间5—21d，平均8．2d。病理检查结果提示前列腺底部切缘阳性1例，前列腺尖部切缘阳性1例。30例术后均获随访，随访6个月，17例保持勃起功能，13例丧失勃起功能。结论DVC、神经血管束和引流管的处理技巧是RALP性功能保留的3个重要方面。RALP保留性功能的安全性好，疗效确切，值得在临床上参考应用。
Objective To evaluate the key technique and effectiveness of potency preservation in robotic-assisted laparoseopic radical prostatectomy （RALP）. Methods The complete clinical and follow-up data of 30 cases underwent RALP between February and May of 2016 were reviewed retrospectively. The average age of the patients was 67.3 years （48 - 82 years）. The peak PSA level before surgery ranged from 7.6 to 53.4 ng/ml with the average level of 21.1 ng/ml. There were 7, 16, 6 and 1 case with the Gleason score of 6, 7, 8, and 9 point, respectively. Preoperative erectile score （ IIEF-5 ） of the 30 patients were llst as below： 3 cases （0- 10 points）, 4 cases（ 11 -15 points）, 17 cases（ 16 -20 points）, and 6 cases（21 - 25 points）. The key techniques of potency preservation during RALRP includes deep dorsal vein ligation techniques, neurovascular bundles preservation techniques and drain tube placement techniques. Results All 30 cases underwent operation successfully with no transfer to open surgery. Average operative time was 150.7 rain （98 -240 rain） with an estimated blood loss of 165.7ml （50 -550 ml）. The average drainage removal time was 5.1 d postoperatively. The average bowel recovery time was 2.7 d and average hospitalization time was 8.2 d, respectively. There were two cases with one positive margin on the bladder neck and one on the tip of prostate, respectively. Seventeen cases gained potency preservation six months after surgery. Conclusion It was safe and beneficial for the potency preservation in RALP, which could be considered as one of the best options for the prostate cancer surgery.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2017年第6期417-420,共4页
Chinese Journal of Urology
基金
国家高技术研究发展计划（863计划）（2012AA02101）
关键词
前列腺癌
机器人辅助手术
性功能保留
Prostatic neoplasms
Robotic-assisted surgery
Potency preservation
