摘要
目的探讨全息影像技术在机器人根治性前列腺切除术(RARP)中的应用效果。方法回顾性分析2020年10-12月解放军总医院第三医学中心行RARP的34例前列腺癌患者的临床资料。平均年龄67.8(52~78)岁,平均体质指数25.8(18.0~32.3)kg/m^(2)。术前中位PSA 13.4(2~149)ng/ml,中位前列腺体积31.7(9.5~159.1)ml。欧洲泌尿外科学会(EAU)生化复发风险分级:低风险5例,中风险7例,高风险22例。美国麻醉医师协会(ASA)评分:1分9例,2分16例,3分9例。术前Gleason评分:≤6分9例,7分15例,≥8分10例。术前病理分期:≤cT_(2a)期13例,cT_(2b)期1例,≥cT_(2c)期20例。根据患者术前高分辨率多参数MRI数据、影像学诊断报告及术前穿刺病理报告重建患者的全息影像。术前对全息影像进行旋转、组合、拆分、隐藏等操作,术者可以更加直观地了解肿瘤的大小、位置、周围神经血管分布,有助于术前手术规划;术中通过手动体外配准,术者可以更加精准地识别膀胱内括约肌及处于其后方的膀胱前列腺肌、神经血管束、膜部尿道、精囊等结构,提高手术精准度。记录患者围手术期指标,分析患者术后尿控制及性功能恢复情况。结果34例手术均顺利完成,无中转开放。中位手术时间157.5(95~276)min;中位出血量50(20~300)ml,所有患者术中均未输血。中位术后引流管留置时间2(1~5)d;中位术后住院时间3.5(2~8)d;中位术后导尿管拔除时间20.5(11~22)d。术后Gleason评分≤6分2例,7分16例,≥8分8例,8例因行内分泌治疗无法评分。术后病理分期≤T_(2a)期10例,T_(2b)期1例,≥T_(2c)期23例。22例术中行扩大盆腔淋巴结清扫,1例右髂窝淋巴结转移;2例切缘阳性。3例出现Clavien-DindoⅠ级并发症。术后1、3个月尿控恢复率分别为47.1%(16/34)和79.4%(27/34);术后3个月8例恢复勃起功能。结论全息影像技术可有助于肿瘤的完整切除,利于术后早期尿控恢复,降低围手术期并发症发生率,是前列腺癌精准外科治疗的术中保障。
Objective To evaluate the efficacy of holographic image technology in robot-assisted laparoscopic radical prostatectomy(RARP).Methods The clinical data of 34 patients with prostate cancer who underwent RARP in our hospital during October 2020 and December 2020 was analyzed retrospectively.The average age of the patients was 67.8(52-78)years.The mean BMI was 25.8(18.0-32.3)kg/m^(2).The median level of PSA before surgery was 13.4(2-149)ng/ml.Median prostate volume was 31.7(9.5-159.1)ml.EAU risk groups for biochemical recurrence of localised and locally advanced prostate cancer were list as below:5 cases of low-risk,7 cases of medium-risk,22 cases of high-risk.There were 9,16,9 cases with the ASA score of 1,2,3 point,respectively.Preoperative Gleason score of 34 patients were list as below:9 cases in score≤6 group,15 cases in score=7 group,10 cases in score≥8 group.For clinical stage before the surgery,13 cases≤T_(2a) stage,1 case in T_(2b) stage,20 cases≥T_(2c) stage.The engineers established holographic images of 34 patients based on multiparametric magnetic resonance imaging(mpMRI)and the reports before the operation.Surgeons can obtain the size and location of tumors,surrounding neurovascular bundles visually by revolving,assembling,disassembling and concealing images,which was helpful for pre-surgery planning.By manipulating the holographic images extracorporeally,surgeons can discriminate Internal sphincter of urinary bladder and vesicoprostatic muscle,neurovascular bundles,membranous part,seminal vesicle easily,which improves the operation accuracy.Results All 34 cases underwent operation successfully without transferring to open surgery.The median operative time was 157.5(95-276)min with an estimated blood loss of 50(20-300)ml.The median drainage removal time was 2 d and median hospitalization time was 3.5 d,respectively.The catheters were removed within an average time of 20.5 d.For postoperative Gleason score,there were 2 cases in score≤6 group,16 cases in score=7 group,8 cases in score≥8 group and 8 cases can’t make a score.For clinical stage after the surgery,10 cases were≤T_(2a) stage,1 case was T_(2b) stage,23 cases were≥cT_(2c) stage.22 cases underwent pelvic lymph node dissection,including a patient with right iliac fossa lymph node metastasis.There were 2 cases with positive surgical margin and 3 cases with Clavien-DindoⅠcomplications.The rate of 1-month and 3-month urinary continence were 47.1%and79.4%,respectively,8 cases recovered erectile function after 3 month.Conclusions Holographic image technology can promote cancer dissection completely,achieve urinary continence early and reduce perioperative complications tremendously.The technology is the"intraoperative security"for the accurate surgical treatment of prostate cancer.
作者
陈欣然
王保军
高宇
朱捷
牛少曦
黄庆波
吕香君
李新涛
石统帅
康欢欢
王海屹
马鑫
张旭
Chen Xinran;Wang Baojun;Gao Yu;Zhu Jie;Niu Shaoxi;Huang Qingbo;Lyu Xiangjun;Li Xintao;Shi Tongshuai;Kang Huanhuan;Wang Haiyi;Ma Xin;Zhang Xu(Department of Urology,Third Medical Center,PLA General Hospital,Beijing 100853,China;Department of Radiology,First Medical Center,PLA General Hospital,Beijing 100853,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2021年第7期497-501,共5页
Chinese Journal of Urology
