机器人辅助与经腹膜外途径腹腔镜下根治性前列腺切除术的近期疗效比较

摘要

目的 比较机器人辅助腹腔镜下根治性前列腺切除术(robot-assisted laparoscopic prostatectomy,RALP)与经腹膜外途径腹腔镜下根治性前列腺切除术(extraperitoneal laparoscopic radical prostatectomy,ELRP)的近期临床疗效. 方法 回顾性分析2012年1-12月收治的160例前列腺癌患者的临床资料.RALP组86例,年龄46 ～ 75岁,中位年龄67岁.术前PSA 4.28～126.26μg/L,中位数15.20 μg/L.ELRP组74例,年龄45～78岁,中位年龄68岁.术前PSA 4.65～ 131.35μg/L,中位数17.32μg/L.比较两组的围手术期疗效、近期肿瘤控制情况、术后控尿功能及勃起功能的恢复状况. 结果 两组手术均顺利完成,无中转开放手术,均未输血.RALP组手术时间80～ 145 min,中位时间90 min,估计失血量20 ～ 280 ml,中位值60 ml; ELRP组手术时间60～ 130 min,中位时间85 min,估计失血量20～ 300 ml,中位值70 ml,两组比较差异均无统计学意义(P＞0.05).两组各有5例切缘阳性,差异无统计学意义(P＞0.05).术后随访10～21个月,RALP组和ELRP组分别有7例和5例患者失访.所有随访患者均生存,RALP组和ELRP组分别有6例和5例生化复发并接受内分泌治疗.两组术后均无持续性漏尿或吻合口狭窄发生.术后12～ 18个月,RALP组和ELRP组患者均恢复完全的控尿功能,差异无统计学意义(P＞0.05).RALP组和ELRP组分别有55例和53例保留双侧神经血管束,术后6、12个月RALP组分别有30例和40例;ELRP组分别有18例和27例对阴茎勃起硬度和持续时间满意,差异均有统计学意义(P＜0.05). 结论 RALP与ELRP相比,围手术期效果、近期肿瘤控制情况和术后控尿功能恢复相似,术后近期勃起功能恢复较好.%Objective To compare the short-term effect between robot-assisted laparoscopic prostatectomy (RALP) and extraperitoneal laparoscopic radical prostatectomy (ELRP).Methods Between January,2012 and December,2012,the data of 160 cases with prostate cancer was reviewed.Among them,86 cases were underwent the RALP with da Vinci S system (Intuitive Surgical Inc.).The median age was 67 years old (ranged 46-75 years) and the median preoperative t-PSA level was 15.20 μg/L (ranged 4.28-126.26 μg/L).At the same time,74 cases of ELRP were performed,in whom the median age was 68 years (ranged 45-78 years) and the median preoperative t-PSA level was 17.32 μg/L (ranged 4.65-131.35 μg/L).Perioperative data,short-term oncological control,recovery of continence and potency were analyzed retrospectively.Results All the operations were successful without conversion.In the RALP group,the median operative time was 90 min (ranged 80-145 min) and the median estimated blood loss was 60 ml (20-280 ml).In the ELRP group,the median operative time was 85 min (60-130 min) and the median estimated blood loss was 70 ml (20-300 ml).The differences of operative time and estimated blood loss in both groups were all not statistically significant (P=0.325 and P=0.466).The differences of pathological Gleason scores,the pathological stages and positive surgical margin rates in both groups were all not significant (P=0.523,P=0.739 and P=0.735).During the 10-21 months follow-up,7 cases and 5 cases were lost in RALP and ELRP group,respectively.Six cases and 5 cases were diagnosed as the biochemical recurrence and accepted the endocrine therapy in RALP and ELRP group,respectively.Equally continent results in both groups were found (P＞0.05).The neurovascular bundle preserved procedure was conducted in RALP (n =55) and ELRP (n =53) group,respectively.Better postoperative potency rates at 6 months (30 vs 18) and 12 months (40 vs 27) were found in RALP group (P=0.048 and P=0.025,respectively).Conclusion Compared to ELRP,RALP can provide similar perioperative data,short-term oncological control,recovery of postoperative continence and better postoperative potency rates.