附20例报告腹膜外途径机器人辅助腹腔镜根治性前列腺切除.PDFVIP

2012;32(5) 南方医科大学学报（J South Med Univ ） ·749 · 临床研究 腹膜外途径机器人辅助腹腔镜根治性前列腺切除术：附20 例报告 王 威，高江平，徐阿祥，朱 捷，陈文政，卢锦山，张 旭 解放军总医院泌尿外科，北京 100853 摘要：目的探讨腹膜外途径机器人辅助腹腔镜根治性前列腺切除术的初步经验。方法 前列腺腺癌患者20 例，平均年龄65.6 （50~75）岁。患者全部是在B 超引导下经直肠前列腺穿刺活检病理证实为前列腺癌。Gleason 评分≤6 分7 例，7 分10例，8分2 例，9 分1例。影像学检查未见淋巴结及远处转移。病例均采用机器人辅助腹腔镜腹膜外顺行根治性前列腺切除术治疗。结 果 本组病例均顺利完成，未因任何原因更改术式。4 例病例术后4 周PSA0.2 ng/ml ，提示术后肿瘤残留，先行雄激素去除治 疗，择期再行外放射治疗。16例随访时间平均15.5（10~37）月。20 例中机器人安装时间平均48.5（40~60）min ，手术平均时间 180（150~230）min ，患者术中平均失血量298（80~800）ml ，术后恢复进食时间平均1.7（1~3）d ，留置尿管时间平均10.7（7~ 14）d ， 住院时间平均10.7（7~ 14）d。无手术并发症发生。术后病理Gleason 评分≤6分6例，7分5例，≥8分9例。结论 机器人辅助腹 腔镜根治性前列腺切除术使腹腔镜易于被术者掌握，尤其在盆腔复杂手术方面的优点十分突出。 关键词：机器人；腹腔镜；前列腺癌 中图分类号：R697.3 文献标志码：A 文章编号：1673-4254（2012）05-0749-03 doi: 10.3969/j.issn. 1673-4254.2012.05.038 /kcms/detail/44.1627.R1651.017.html Extraperitoneal robot-assisted laparoscopic radical prostatectomy: report of 20 cases WANG Wei, GAO Jiangping, XU Axiang, ZHU Jie, CHEN Wenzheng, LU Jinshan, ZHANG Xu Department of Urology, General Hospital of PLA, Beijing 100853, China Abstract: Objective To summarize our experience with extraperitoneal robot-assisted laparoscopic radical prostatectomy (RLRP). Methods Twenty patients with confirmed prostate cancer by transrectal needle biopsy but no metastasis detected by radiographic examination underwent extraperitoneal RLRP, including 7 with Gleason score of less than 6, 10 with a score of 7, 2 with a score of 8, and 1 with a score of 9. Results The procedures were performed successfully in all the patients. In 4 cases, a postoperative PSA value of more than 0.2 ng/ml at 4 weeks suggested residual tumor, for which maximal androgen block therapy was administered before elective raditherapy. Sixteen patients were followed up for 10 to 37 months (mean