保留Retzius间隙的机器人前列腺癌根治术在前列腺中叶突出患者中应用

目的   报道首个应用保留Retzius间隙的机器人前列腺癌根治术(RS RARP)治疗具有前列腺中叶突出(PML)的前列腺癌患者的病例系列研究,并评价RS RARP在PML前列腺癌患者中的应用价值。方法   收集2017年7月至2019年1月间于南京大学医学院附属鼓楼医院泌尿外科(南京大学泌尿外科研究所)接受同一外科医生行RS RARP手术的有着明显PML的局限性前列腺癌患者的临床资料。所有患者行前列腺多参数核磁共振(mpMRI)检查。PML由T2加权的正中矢状面图像上进行测量。所有患者随访时间超过1个月。所有患者的病理切片由同一名泌尿外科病理医师进行判读。对患者基本情况、围手术期结果、切缘阳性率和早期尿控恢复进行研究。结果  本研究共入组患者41例,中位年龄、中位体质量指数(BMI)、中位初始前列腺特异性抗原(PSA)水平、中位经直肠超声前列腺体积、中位PML、中位手术用时、中位估计手术出血量及中位住院时间分别为:700(67～75)岁, 240(217～263)kg／m2, 84(55～154) ng／ml,408(324～474) ml,116(105～131)mm,1550(1400～1850)min,2000(125～300)ml,50(45～80)d。研究中,共有7例患者切缘阳性,总体切缘阳性率为171％（7/41）。前列腺基底切缘阳性率为0。在pT2期患者中,切缘阳性率为77％(2／26);在pT3期患者中,切缘阳性率为333％(5／15)。659％(27／41)的患者术后1个月内即恢复尿控, 512％(21／41)的患者术后即刻恢复尿控。结论 对于PML患者,保留Retzius间隙的机器人辅助根治性前列腺癌切除术(RS RARP)在控制切缘阳性率的前提下,能够改善患者术后早期尿控的恢复。 【关键词】前列腺癌根治术;机器人辅助;保留Retzius间隙;中叶突出;切缘阳性率;早期尿控 doi：10.3969/j.issn.1674-4136.2019.02.002 文章编号：1674-4136（2019）02-0083-05 Application of Retzius sparing robot assisted radical prostatectomy for patients with median lobe protrusionXU Liu, ZHANG Mengjie, ZHUANG Junlong,QIU Xuefeng, XU Linfeng, GUO Hongqian.(Department of Urology, Drum Tower Hospital, Medical School of Nanjing University;Institute of Urology, Nanjing University, Nanjing 210008, China) Corresponding author: GUO Hongqian, Email: dr.ghq@nju.edu.cn 【Abstract】ObjectiveTo introduce the first case series receiving RS RARP for prostate cancer with PML, and evaluate the potential advantage. MethodsConsecutive clinical data of patients with significant PML who received RS RARP by the same surgeon in our center between July 2017 and January 2019 was analyzed retrospectively. All patients underwent pelvic mpMRI which PML measured from. All pathologic images were confirmed by a genitourinary pathologist. The basic information, perioperative outcomes, rate of positive surgical margin and early urinary continence were analyzed. ResultsThe median age, BMI, preoperative total PSA level, prostate volume, PML, operative time, estimated blood loss and length of hospital stay were 700(67 75)years,240(217 263)kg／m2, 84(55 154)ng／ml, 408(324 474) ml,116(105 131)mm,1550(1400 1850)min, 2000(125 300)ml,50(45 80)days,respectively. The rate of PSM was 171％(7／41).None had positive base surgical margin. The rates of PSM were 77％(2／26) and 333％(5／15) in pT2 and pT3 patients, respectively. 659％(27／41) of the patients were continent within 1 month, and 512％(21／41) patients were continent within 1 week.  ConclusionsRS RARP can improve early urinary continence with a well positive surgical margin control in PML.     

Comparación de los resultados perioperatorios de la cistectomía radical asistida por robot con derivación urinaria extracorpórea vs. intracorpórea

ObjectivesTo compare perioperative outcomes and complications of robot assisted radical cystectomy (RARC) with extracorporeal (ECUD) vs. intracorporeal urinary diversion (ICUD) for bladder cancer.Material and methodsRetrospective revision of 43 patients who underwent RARC for bladder cancer between 2015-2018 with at least 3 months of follow-up. The analysis included the initial series of RARC performed by one surgeon with extensive experience in open radical cystectomy.ResultsForty-three patients, 40 men (93%) and 3 women (7%), with a median age of 65 years (44-83) and mean follow-up of 27.7 months (±20.1) underwent RARC. A ECUD was performed in 22 cases (51%), of whom 10 were ileal conduits (45.5%) and 12 neobladders (54.5), and ICUD in 21 cases (49%), of whom 14 were ileal conduits (66.7%) and 7 neobladders (33.3%). Clinical and preoperative characteristics were similar in both groups. The median operative time was 360 minutes (240-540) and length of hospital stay was 12 days (7-73). Thirty-five patients (81%) had postoperative complications, of whom 10 (23%) were major. Operative time, peroperative complications, pathological stage, positive margins, and number of lymph nodes removed did not significantly differ among groups. Patients who underwent ECUD had a higher rate of uretero-ileal strictures than those with ICUD (45.5% vs. 14.3%, P = .026). Among the neobladders, the ECUD developed a higher rate of urethro-neobladder stricture than the ICUD (33% vs. 0%, P = .044).ConclusionsRARC with ICUD achieved peroperative outcomes and complication rates comparable than those with ECUD. The ICUD could reduce the risk of developing uretero-ileal and urethro-neobladder strictures.     

手术机器人系统在颅颌面外科中的应用及发展

近年来机器人辅助外科手术以其微创、精准、安全的特点受到了越来越多的关注。颅颌面外科传统手术严重影响美观。机器人辅助手术延伸了医生的视觉范围和可操作空间,提高了手术效果及患者术后生活质量。本文对手术机器人系统的发展以及近年来在颅颌面外科的应用进行综述。     

基于体感交互的骨折复位机器人控制方法实验研究

将基于体感交互的控制方法引入骨折复位机器人,通过实验研究验证该方法的控制精度以及学习曲线,从而评估该方法的控制效果和学习的难易程度。利用Kinect采集操作者的手势以及手臂的运动状态作为控制参数,经计算机程序识别处理后生成机器人控制指令,从而控制机器人在模型骨上完成骨折复位操作。由6位操作者进行共计60次复位实验,得出复位精度和学习曲线数据。 6位操作者的复位平均距离误差为(4.10±0.77)mm,角度误差为3.25°±1.11°。通过学习曲线分析发现,从第6次实验开始,操作所用时间显著缩短。将基于体感交互用的控制方法用于骨折复位机器人控制,不仅能够满足复位精度要求,而且操作学习时间短。该方法可为手术机器人的人机交互提供一种新的有效方法。     

腿足式救援机器人运动控制算法分析与展望

介绍了当前国内外腿足式救援机器人的模型控制算法、仿生控制算法和机器学习控制算法,对3种控制算法的应用特点和场景进行了优缺点分析.指出了腿足式救援机器人控制技术未来的2个发展方向是多控制算法融合和控制算法高效规划.     

基于SWOT法治未病现代化装备发展战略研究＊

采用SWOT分析法，对治未病现代化装备进行分析，明确其当前发展存在的优势、劣势、机遇和威胁，并且为其制定相应的SO、ST、WO、WT发展策略，以期为推动治未病现代化装备战略取得积极成效、谋求治未病现代化长远健康发展提供参考。