介绍全息影像在机器人辅助前列腺癌根治术中保留膀胱颈技术的应用及初步体会。

回顾性分析中国人民解放军中部战区总医院泌尿外科2020年1月至2021年12月收治的机器人辅助前列腺癌根治术中使用全息影像保留膀胱颈技术的43例前列腺患者的临床资料。全息影像在机器人辅助前列腺癌根治术中保留膀胱颈技术要点：（1）全息影像定位双侧精囊腺；（2）以精囊腺为起点，沿精囊筋膜和膀胱颈后壁游离，保留膀胱前列腺肌；（3）彻底游离膀胱颈后壁，挑起膀胱颈，精准辨识膀胱颈后完整离断。记录患者围手术期相关数据，分析术后患者早期尿控及性功能恢复情况。

43例手术均成功保留膀胱颈，平均手术时间为（171±12）min，平均出血量为（90±10）ml，所有患者围手术期均未输血，术后平均住院（10.2±1.2） d，术后留置尿管时间为（9.1±0.5）d。术后病理分期≤T_2a期20例，T_2b期10例，≥T_2c期13例；2例淋巴结转移，3例切缘阳性。4例出现Clavien-Dindo Ⅰ级并发症。术后1个月和3个月尿控恢复率分别为48.8%（21/43）和79%（34/43）；术后3个月10例恢复勃起功能。

全息影像应用于机器人辅助前列腺癌根治术中保留膀胱颈成功率高，术后并发症少，早期尿控恢复率高，值得推广。

To introduce the application of holographic image in bladder neck preservation during robot-assisted radical prostatectomy (RARP).

The clinical data of 43 patients who underwent robot-assisted radical prostatectomy in General Hospital of the Central Theater Command from January 2020 to December 2021 were analyzed retrospectively. The key procedures of bladder neck preservation during RARP were as follows: (1) localization of bilateral seminal vesicle by holographic image; (2) take the seminal vesicle as the starting point, dissociate along the seminal vesicle fascia and the posterior wall of the bladder neck, and retain the vesico prostatic muscle; (3) the posterior wall of the bladder neck was completely dissociated, and the bladder neck was lifted to accurately identify and preserve it. The perioperative data of patients were collected and analyzed.

All the 43 patients received bladder neck preservation successfully, with average operation time of (171±12) min and average amount of blood loss of (90±10) ml. The average hospitalization time was (10.2±1.2) days and the catheter was removed in (9.1±0.5) days after surgery. For pathological stage after surgery, there were 20 cases ≤T_2a stage, 10 cases in T_2b stage, 13 cases≥T_2c stage. There were 2 cases with lymph node metastasis, 3 cases with positive margins, 4 cases with Clavien-Dindo grade Ⅰ complication. The urinary control rate was 48.8%(21/43) and 79%(34/43) after 1 and 3 months, respectively. Erectile function of ten patients recovered 3 months after surgery.

The application of holographic image in robot-assisted radical prostatectomy of prostate cancer has a high successful rate of preserving bladder neck, less postoperative complications, and high recovery rate of early urinary control, which is worthy of promotion.