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中华腔镜泌尿外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (05) : 394 -399. doi: 10.3877/cma.j.issn.1674-3253.2022.05.003

临床研究

改良耻骨上入路(SAHZU法)机器人辅助前列腺癌根治术
郑嘉文1, 李忠义1, 徐臻1, 郑一春1, 经霄1,()   
  1. 1. 310009 杭州,浙江大学医学院附属第二医院泌尿外科
  • 收稿日期:2021-08-16 出版日期:2022-10-01
  • 通信作者: 经霄
  • 基金资助:
    浙江省卫生健康委员会医药卫生科技项目(2020375998); 浙江省自然科学基金项目(L Y16H280001)

Modified suprapubic approach (SAHZU) for robot-assisted laparoscopic radical prostatectomy

Jiawen Zheng1, Zhongyi Li1, Zhen Xu1, Yichun Zheng1, Xiao Jing1,()   

  1. 1. Department of Urology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
  • Received:2021-08-16 Published:2022-10-01
  • Corresponding author: Xiao Jing
引用本文:

郑嘉文, 李忠义, 徐臻, 郑一春, 经霄. 改良耻骨上入路(SAHZU法)机器人辅助前列腺癌根治术[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2022, 16(05): 394-399.

Jiawen Zheng, Zhongyi Li, Zhen Xu, Yichun Zheng, Xiao Jing. Modified suprapubic approach (SAHZU) for robot-assisted laparoscopic radical prostatectomy[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(05): 394-399.

目的

探讨改良耻骨上入路(SAHZU法)机器人辅助前列腺癌根治术治疗前列腺癌(RALP)的安全性及效果。

方法

回顾性分析2020年1月至2020年8月在我院接受SAHZU-RALP手术的19例前列腺癌患者的临床资料,包括:患者一般资料、围手术期指标、尿控、性功能和并发症等。

结果

19例患者均顺利完成手术,无术中并发症或中转开放手术,手术切缘均阴性。平均手术时间为(113±13)min,平均失血量为(47±12)ml。术后中位住院时间(IQR)为3(1~3)d,术后留置Foley导尿管的中位时间(IQR)为7(6~7) d,留置引流管的中位时间(IQR)为1(0~2) d。在早期功能方面,7例患者拔除尿管后可即刻尿控(0~1个垫片/d),术后随访至6个月时,有14例患者可完全尿控,8例患者勃起功能满意(IIEF评分≥18)。

结论

采用SAHZU-RALP治疗局限性前列腺癌在技术上是可行的。这项技术只需四个小切口,无需使用特伦德伦伯格(Trendelenburg)体位即可顺利完成手术,对肿瘤根治疗效好,术后尿控恢复满意,并发症少,但需要长期的随访数据,更多的患者以及临床随机对照研究来验证其疗效。

Objective

To explore the safty and effect of the modified suprapubic robot-assisted laparoscopic radical prostatectomy (SAHZU-RALP) in treating prostate cancer.

Methods

All demographics, Perioperative data, complications, functional results and oncologic data of patients who underwent suprapubic SAHZU-RALP from January 2020 to August 2020 were recorded.

Results

Nineteen consecutive patients underwent SAHZU-RALP. The mean operative time was (113±13) min. The mean blood loss was (47±12) ml. All cases were completed without intraoperative complications or conversions. The median (IQR) time of postoperative hospitalization was 3(1-3) days. The median (IQR) time with a Foley catheter after surgery was 7(6-7) days. The median (IQR) time with a drainage tube was 1(0-2) day. No patient had positive surgical margins and postoperative complications. On early functional outcomes, 7 patients had instant urinary control (0-1 pads/day) when the Foley catheter were removed. Fourteen patients were recorded as full urinary control and 8 patients had erectile satisfaction for intercourse (IIEF score≥18) 6 months after surgery.

Conclusions

SAHZU-RALP is technically feasible for patients with organ-confined prostate cancer. In our experience, potential advantages were founded including four small incisions, no Trendelenburg position and minor postoperative complications. But long-term follow-up data, more patients and clinical randomized controlled trials are needed to verify its efficacy.

图2 标准前入路腹膜外RALP操作步骤
表1 19例前列腺癌患者术前临床资料
表2 19例行SAHZU法RALP的患者围手术期资料
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