摘要
目的:探究机器人辅助前列腺癌根治术(RARP)中免缝扎背深静脉复合体(DVC)对术中失血、肿瘤控制效果、术后控尿功能恢复的影响。方法:回顾性分析本院2015年10月至2019年6月接受机器人辅助前列腺癌根治术的154例患者的病历资料,比较免缝扎DVC和常规缝扎DVC患者的相关指标,包括手术时间、术中出血量、术中输血率、切缘阳性率以及拔管后即刻、1、3个月尿失禁发生率。结果:免缝扎DVC组(A组)40例,常规缝扎DVC组(B组)114例。两组患者一般特征,包括年龄、体重质量指数(BMI)、前列腺癌危险分级及美国麻醉师协会(ASA)分级无统计学差异(P>0.05)。A组平均手术时间107.20 min显著短于B组113.25 min(P<0.05)。两组反映术中失血的指标Z值改变量分别为2.11与1.24(P>0.05),术中输血率分别为10.0%与15.8%,两组术中失血无统计学差异(P>0.05)。A组术后总体切缘阳性率15.0%和前列腺尖部切缘阳性率7.5%均与B组的15.8%和8.8%无显著差异(P>0.05;P>0.05),两种DVC处理对肿瘤的控制效果没有区别。A组拔管后即刻尿失禁发生率2.5%,和拔管后1个月尿失禁发生率0,均显著低于B组的17.5%和14.0%(P<0.05;P<0.05),但拔管后3个月,A组(0)与B组(7.9%)无显著差异(P>0.05)。结论:机器人辅助前列腺癌根治术中该DVC免缝扎技术在不会导致术中失血增加且切除肿瘤效果相当的情况下,缩短手术时间,促进术后尿控功能恢复。
Objective:To investigate the application of the deep dorsal vein complex(DVC)ligation-free technique in robot-assisted radical prostatectomy(RARP)and its effects on the intraoperative blood loss,incidence of positive surgical margin(PSM)and urinary continence of the patient.Methods:Totally 154 PCa patients underwent RARP between October 2015 and June 2019,40 with the DVC ligation-free technique(group A)and the other 114 by conventional DVC ligation(group B).We compared the baseline characteristics,operation time,intraoperative blood loss,blood transfusion rate,and postoperative incidences of PSM and urinary incontinence immediately and at 1 and 3 months after catheter removal between the two groups.Results:There were no statistically significant differences between the groups A and B in age,body mass index,PCa risk levels or American Scoiety of Anesthesiology(ASA)tumor grades(P>0.05),nor in intraoperative blood loss(ΔZ:[2.11±8.88]vs[1.24±14.70]g/L,P>0.05),blood transfusion rate(10.0%vs 15.8%,P>0.05),overall PSM incidence(15.0%vs 15.8%,P>0.05)or apical PSM rate(7.5%vs 8.8%,P>0.05).The mean operation time was remarkably shorter in group A than in B(107.20 min vs 113.25 min,P<0.05)and the postoperative incidence rate of urinary incontinence was markedly lower in the former than in the latter group immediately after(2.5%vs 17.5%,P<0.05)and at 1 month after catheter removal(0 vs 14.0%,P<0.05),but with no statistically significant difference between the two groups at 3 months(0 vs 7.9%,P>0.05).Conclusion:The DVC ligation-free technique in RARP can reduce the operation time and promote the recovery of urinary continence in PCa patients without increasing intraoperative blood loss and the incidence of PSM.
作者
程旭
黄智超
彭谋
王荫槐
CHENG Xu;HAUNG Zhi-chao;PENG Mou;WANG Yin-huai(Department of Urology,The Second Xiangya Hospital,Central South University,Changsha,Hunan 410011,China)
出处
《中华男科学杂志》
CAS
CSCD
北大核心
2020年第6期528-531,共4页
National Journal of Andrology
关键词
机器人
前列腺癌根治
DVC
出血
切缘阳性
控尿
robot-assisted radical prostatectomy
dorsal vein complex
blood loss
positive surgical margin
urinary continence
