摘要
目的:评估经腹膜外单切口机器人辅助腹腔镜根治性前列腺切除术-改良通道建立的可行性及初步效果。方法:回顾性分析四川省人民医院机器人微创中心2020年11月至2021年1月单术者开展的35例经腹膜外单切口机器人辅助腹腔镜根治性前列腺切除术(无多通道单孔腹腔镜穿刺装置)治疗局限性前列腺癌患者的临床资料。所有手术均不依赖多通道单孔腹腔镜穿刺装置建立通道。记录手术情况、手术费用、术后并发症、病理及随访结果等。结果:35例手术均顺利完成,无中转开放或增加额外操作通道。平均手术时间为67.3(35.0~125.0)min;建立腹膜外间隙及安装机械臂平均时间为25.4(20.0~45.0)min;术中平均出血量为75.5(60.0~150.0)ml;术后住院时间为7.89(7~10)d;术后肛门排气时间为26(8~48)h;无严重并发症;术后病理Gleason评分3+3分9例(25.7%)、3+4分9例(25.7%)、4+3分8例(22.9%)≥8分9例(25.7%),病理类型均为腺癌;术后病理分期<pT_(3a) 23例(65.7%),≥pT_(3a) 12例(34.3%);整体切缘阳性率为20%(7/35),其中≥pT_(3a)患者切缘阳性率为33.3%(4/12),<pT_(3a)患者切缘阳性率为13.0%(3/23);术后引流管平均留置时间2.68(2~7)d;术后尿管留置时间为6.78(6~9)d;术后即刻尿控满意患者为11例(31.4%),平均随访时间为1.88(1~3)个月,术后1个月尿控恢复29例(82.8%);平均切口长度为4.97(4.6~5.8)cm;与本中心使用多通道单孔腹腔镜手术穿刺装置的单孔机器人手术相比较,节约手术费用。结论:经腹膜外单切口机器人辅助腹腔镜根治性前列腺切除术改良通道建立安全可行,无需使用单孔多通道器械装置,节约手术费用,且具有良好适用性和美容效果。术后恢复快,短期瘤控及尿控效果好,无严重并发症发生。
Objective:To assess the feasibility and validity of the establishment of a modified channel for extraperitoneal robot-assisted laparoscopic radical prostatectomy(RARP)through single incision.Methods:From November 2020 to January 2021,35 cases of localized PCa were treated by extraperitoneal RARP through single incision in our center.All the operations were performed by the same surgeon,none via the multichannel port for the establishment of the channel.We recorded and analyzed the intra-and postoperative parameters,operation cost,complications,pathological findings and follow-up data.Results:All the operations were successfully completed,without conversion to open surgery or additional channels,or serious postoperative complications,the time for establishing the extraperitoneal space averaging 25.4(20.0-45.0)min,the operation time 67.3(35.0-125.0)min,intraoperative blood loss 75.5(60.0-150.0)ml,time to first postoperative anal exhaust 26(8-48)h,and postoperative hospital stay 7.89(7-10)d.Postoperative pathology showed adenocarcinoma in all the cases,with Gleason score(GS)3+3 in 9(25.7%),GS 3+4 in 9(25.7%),GS 4+3 in 8(22.9%),and GS≥8 in 9(25.7%)of the cases,23(65.7%)in the<pT_(3a)and 12(34.3%)in the≥pT_(3a) stage,with a total positive margin rate of 20%(7/35),13.0%(3/23)in the<pT_(3a) group and 33.3%(4/12)in the≥pT_(3a) group.The time of drainage tube indwelling averaged 2.68(2-7)d and urinary catheterization 6.78(6-9)d.Urinary continence was achieved in 11 cases(31.4%)immediately after catheter removal and in 29 cases(82.8%)at 1 month after surgery.The mean incision length was 4.97(4.6-5.8)cm and the average follow-up time was 1.88(1-3)months.The total cost was about￥6000 less than that of the robotic surgery via a multichannel port.Conclusion:The establishment of the modified channel for extraperitoneal RARP through single incision is a safe and feasible procedure,with the advantages of good cosmesis,fast recovery,effective tumor control and continence,no serious postoperative complications,and less cost
作者
周放
任尚青
范世达
吕倩
陈正军
欧勇
聂钰
田景芝
黄娇娇
王东
ZHOU Fang;REN Shang-qing;FAN Shi-da;LüQian;CHEN Zheng-jun;OU Yong;NIE Yu;TIAN Jing-zhi;HUANG Jiao-jiao;WANG Dong(Center of Robot Minimally Invasive Surgery,Sichuan Academy of Medical Sciences,Sichuan Provincial People’s Hospital,Chengdu,Sichuan 610000,China)
出处
《中华男科学杂志》
CAS
CSCD
北大核心
2021年第10期892-898,共7页
National Journal of Andrology
