目的

探讨前后结合入路机器人辅助根治性前列腺切除术（AP-RARP）治疗前列腺癌的安全性和早期疗效。

方法

收集2019年12月至2021年12月南京鼓楼医院收治的82例行AP-PARP前列腺癌患者的病例资料。手术操作首先经后入路分离精囊、输精管和前列腺后壁，而后改为经前入路完成剩余手术步骤。统计患者围手术期及术后早期并发症相关指标（吻合口尿瘘、感染等），并统计患者病理切缘阳性率、术后尿控率、勃起功能情况。

结果

82例手术均顺利完成。平均手术时间（105±13）min，平均术中出血量（139±62）ml，无输血患者，术后吻合口尿瘘1例，术后感染2例。T2期患者术后切缘阳性率7.0%（4/57），T3a期患者术后切缘阳性率28.0%（7/25）。术后拔尿管即刻、术后1个月、3个月和6个月尿控恢复率分别为17.1%（14/82）、46.3%（38/82）、84.1%（69/82）、98.8%（81/82），患者术后6个月国际勃起功能指数（IIEF-5）指数12（0，17）。

结论

AP-RARP结合了前入路RARP和保留Retzius间隙的RARP的优势，是治疗前列腺癌的可选择手术路径之一。

Objective

To review the safety and efficacy of anterior approach robot-assisted radical prostatectomy （AP-RARP） in the treatment of prostate cancer through a retrospective analysis.

Methods

Clinical data of 82 patients with cT1c-T3a stage prostate cancer who underwent AP-RARP at Nanjing Drum Tower Hospital from December 2019 to December 2021 were collected. The surgical procedure began by initially separating the seminal vesicles， vas deferens， and the posterior wall of the prostate through a posterior approach. Subsequently， the procedure was then switched to an anterior approach to complete the remaining surgical steps. Perioperative and early postoperative complications were recorded， along with postoperative urinary continence rate， erectile function， and positive surgical margin rate.

Results

All 82 surgeries were successfully completed. The average operation time was（105±13） minutes， with an average intraoperative blood loss of （139±62） ml. No blood transfusion was required. Postoperative complications included one case of urinary fistula and two cases of infection.The positive surgical margin rate was 7.0% （4/57） for patients with T2 stage cancer and 28.0% （7/25） for patients with T3a stage cancer. The recovery rates for urinary continence at catheter removal， 1 month，3 months， and 6 months postoperatively were 17.1% （14/82）， 46.3% （38/82）， 84.1% （69/82）， and 98.8%（81/82）， respectively.

Conclusion

AP-RARP combines the advantages of anterior approach RARP and Retzius-sparing RARP， making it one of the viable surgical options for the treatment of prostate cancer.