改良耻骨上入路（SAHZU法）机器人辅助前列腺癌根治术

doi:10.3877/cma.j.issn.1674-3253.2022.05.003

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。

关键词: 前列腺癌, 机器人, 腹腔镜, 前列腺癌根治术, SAHZU法, 耻骨上, 尿失禁

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.

Key words: Prostate cancer, Robot, Laparoscopy, Radical prostatectomy, SAHZU, Suprapubic, Urinary incontinence

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

参数		结果
年龄(岁)		(68±7)^a，(54~78)^b
体重指数BMI(kg/m²)		(24.75±3.70)^a，(17.96~32.37)^b
术前PSA(ng/ml)		(10.64±4.95)^a，(2.72~19.20)^b
ASA评分[例(%)]
	Ⅰ	5(26.3)
	Ⅱ	10(52.6)
	Ⅲ	4(21.1)
前列腺体积(ml)		(32.95±14.26)^a，(8.46~63.47)^b
穿刺Gleason评分[例(%)]
	≤6分	5(26.3)
	7分	7(36.8)
	≥8分	7(36.8)
TNM分期[例(%)]
	T₁	7(36.8)
	T₂	12(63.2)
IIEF评分		(21±4)^a，(13~27)^b

表1 19例前列腺癌患者术前临床资料

参数		结果
年龄(岁)		(68±7)^a，(54~78)^b
体重指数BMI(kg/m²)		(24.75±3.70)^a，(17.96~32.37)^b
术前PSA(ng/ml)		(10.64±4.95)^a，(2.72~19.20)^b
ASA评分[例(%)]
	Ⅰ	5(26.3)
	Ⅱ	10(52.6)
	Ⅲ	4(21.1)
前列腺体积(ml)		(32.95±14.26)^a，(8.46~63.47)^b
穿刺Gleason评分[例(%)]
	≤6分	5(26.3)
	7分	7(36.8)
	≥8分	7(36.8)
TNM分期[例(%)]
	T₁	7(36.8)
	T₂	12(63.2)
IIEF评分		(21±4)^a，(13~27)^b

表2 19例行SAHZU法RALP的患者围手术期资料

参数		结果
失血量(ml)		(47±12)^a，(20~80)^b
手术耗时(min)		(113±13)^a，(85~135)^b
术后住院时间(d)		[3，(1~3)]^c，(1~3)^b
留置导尿时间(d)		[7，(6~7)]^c，(5~9)^b
引流管留置时间(d)		[1，(0~2)]^c，(0~3)^b
并发症[例(%)]		0(0)
切缘阳性[例(%)]		0(0)
术后病理分期[例(%)]
	pT₂	18(94.7)
	pT₃	1(5.3)
术后Gleason评分[例(%)]
	≤6分	1(5.3)
	7分	10(52.6)
	≥8分	8(42.1)
尿控良好[例(%)]
	即刻	7(36.8)
	术后1个月，0~1（片/d）	12(63.2)
	术后6个月，0~1（片/d）	14(73.7)
IIEF评分(分)
	术后1个月	(14±5)^a，(5~23)^b
	术后6个月	(15±5)^a，(9~23)^b
PSA(ng/ml)
	术后1个月	(0.023±0.003)^a，(0~0.115)^b
	术后6个月	(0.008±0.001)^a，(0~0.050)^b

表2 19例行SAHZU法RALP的患者围手术期资料

参数		结果
失血量(ml)		(47±12)^a，(20~80)^b
手术耗时(min)		(113±13)^a，(85~135)^b
术后住院时间(d)		[3，(1~3)]^c，(1~3)^b
留置导尿时间(d)		[7，(6~7)]^c，(5~9)^b
引流管留置时间(d)		[1，(0~2)]^c，(0~3)^b
并发症[例(%)]		0(0)
切缘阳性[例(%)]		0(0)
术后病理分期[例(%)]
	pT₂	18(94.7)
	pT₃	1(5.3)
术后Gleason评分[例(%)]
	≤6分	1(5.3)
	7分	10(52.6)
	≥8分	8(42.1)
尿控良好[例(%)]
	即刻	7(36.8)
	术后1个月，0~1（片/d）	12(63.2)
	术后6个月，0~1（片/d）	14(73.7)
IIEF评分(分)
	术后1个月	(14±5)^a，(5~23)^b
	术后6个月	(15±5)^a，(9~23)^b
PSA(ng/ml)
	术后1个月	(0.023±0.003)^a，(0~0.115)^b
	术后6个月	(0.008±0.001)^a，(0~0.050)^b

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

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