摘要
目的:报告保留Retzius间隙和尿道的机器人辅助单纯前列腺切除术治疗大体积前列腺增生(≥80 ml)的安全性及疗效。方法:回顾性分析2019年8月至2021年6月进行的24例保留Retzius间隙和尿道的机器人辅助单纯前列腺切除术的临床资料,患者年龄68.5(55~80)岁,体质量指数25.1(20.5~34.9)kg/m^(2),术前前列腺体积132.4(85.6~235.7) ml, tPSA 10.8(0.5~37.9)μg/L,IPSS 25(3~35)分,QOL 5(3~8)分。24例中术前因尿潴留导尿12例,膀胱造瘘1例,合并肾积水2例,膀胱结石和膀胱憩室1例;14例经前列腺穿刺活检排除前列腺癌。术后随访时间为3~21个月。记录手术时长、术中失血量、术后第1天血红蛋白下降值、输血率、术中术后并发症;对比分析患者术前后IPSS、 QOL、最大尿流率(Qmax)、残余尿量(PVR)、IIEF、男性性健康问卷(MSHQ)评分变化。结果:24例患者均顺利完成保留Retzius间隙和尿道的机器人辅助单纯前列腺切除术,手术时间175(100~285)min,失血量200(50~800)ml,术后第1天血红蛋白下降值25(4~57)g/L,术后留置引流管时间3(2~7)d,留置尿管时间12(4~18)d,有6例(25%)进行了术中输血治疗;1例患者术后1个月因血尿行经尿道电凝止血术,1例术后12个月因膀胱颈口条索状组织黏连行经尿道膀胱颈口瘢痕组织黏连电切术,其余患者未发生其他并发症。术后患者IPSS 3(1~7)分、QOL 2(0~3)分、Qmax19.6(9.9~32.1)ml/s、PVR 0(0~34.9)ml,均较术前有明显改善(P<0.05)。IIEF 20(19~24)分、MSHQ评分14(13~14)分,未见明显下降(P>0.05)。结论:保留Retzius间隙和尿道的机器人辅助单纯前列腺切除术是一种安全、有效的治疗大体积前列腺增生的微创方法,可改善患者术后排尿功能。
Objective:To report the safety and efficacy of trans-Douglas Retzius'space-sparing robot-assisted simple prostatectomy(RSS-RASP)in the treatment of large-volume BPH.Methods:This retrospective study included 24 cases of large-volume(>80 ml)BPH treated by trans-Douglas RSS-RASP from August 2019 to June 2021.The patients ranged in age from 55 to 80(mean 68.5)years,with an average body mass index of 25.1(20.5-34.9)kg/m^(2),median prostate volume of 132.4(85.6-235.7)ml,and preoperative tPSA of 10.8(0.5-37.9)ng/ml,IPSS of 25(3-35)and quality of life(QOL)score of 5(3-8).Before surgery,12 of the patients received catheterization for urinary retention,1 underwent cystostomy,2 were complicated with hydronephrosis,1 had stones and diverticulum in the bladder,and 14 were excluded from the cases of PCa by prostatic biopsy.The operation time,intraoperative blood loss,hemoglobin level on the first day after surgery,blood transfusion,and intra-and postoperative complications were recorded.The patients were followed up for 3 to 21 months postoperatively.Comparisons were made before and after operation in the IPSS,maximum urinary flow rate(Qmax),postvoid residual volume(PVR),QOL score,IIEF score and Male Sexual Health Questionnaire(MSHQ)score.Results:Trans-Douglas RSS-RASP was successfully completed in all the 24 cases,with a mean operation time of 175(100-285)min,intraoperative blood loss of 200(50-800)ml,hemoglobin decrease of 25(4-57)g/L on the first day after surgery,postoperative drainage tube indwelling of 3(2-7)d,and urinary catheterization of 12(4-18)d.Six(25%)of the patients received intraoperative blood transfusion,1 underwent transurethral electrocoagulation hemostasis 1 month after surgery because of postoperative bleeding,and 1 received transurethral resection of the cicatrical adhesive tissue of the bladder neck 12 months after surgery.No other complications occurred postoperatively.The IPSS(3[1-7]),Qmax(19.6[9.9-32.1]ml/s),PVR(0[0-34.9]ml)and QOL score(2[0-3])of the patients were significantly improved after surgery(P<0.05),but no statistically significant differences were observed in the IIEF(20[19-24])and MSHQ scores(14[13-14])as compared with the baseline(P>0.05).Conclusion:Trans-Douglas RSS-RASP is a safe and effective minimally invasive method for the treatment of large-volume(>80 ml)BPH,which can improve the urinary function of the patient after operation.
作者
陈鑫楠
方昌华
杜霖
王昊
王文帝
张成伟
秦海翔
邓永明
邱雪峰
庄君龙
张士伟
徐林峰
甘卫东
李笑弓
郭宏骞
张古田
CHEN Xin-nan;FANG Chang-hua;DU Lin;WANG Hao;WANG Wen-di;ZHANG Cheng-wei;QIN Hai-xiang;DENG Yong-ming;QIU Xue-feng;ZHUANG Jun-long;ZHANG Shi-wei;GAN Wei-dong;LI Xiao-gong;GUO Hong-qian;ZHANG Gu-tian(Department of Urology,Nanjing Drum Tower Hospital/Gulou School of Clinical Medicine,Nanjing Medical University,Nanjing,Jiangsu 210008,China)
出处
《中华男科学杂志》
CAS
CSCD
北大核心
2022年第11期1006-1010,共5页
National Journal of Andrology
关键词
机器人辅助前列腺切除术
后入路手术
良性前列腺增生
排尿功能
并发症
robot-assisted simple prostatectomy
trans-Douglas approach
benign prostate hyperplasia
urinary function
complications
作者简介
陈鑫楠(1996-),女,江苏无锡市人,医师,硕士研究生,从事泌尿外科工作。Email:chenxinnan123456@163.com;通讯作者:张古田,Email:zhang.gutian@nju.edu.cn
