机器人辅助腹腔镜经腹腔与腹膜外单孔前列腺癌根治术围手术期护理的对比研究

目的:回顾性分析机器人辅助腹腔镜经腹腔与经腹膜外单孔前列腺癌根治术治疗前列腺癌的围手术期护理的疗效,探讨后者的护理优势。方法:回顾性分析四川省人民医院机器人微创中心2019年7月—2020年6月接受机器人辅助腹腔镜前列腺癌根治术的患者142例,其中行机器人辅助腹腔镜经腹腔前列腺癌根治术82例,行机器人辅助腹腔镜经腹膜外单孔前列腺癌根治术60例,所有手术均为同一术者完成。术后随访比较两组患者的手术切口护理情况、引流管拔除时间、疼痛评分、术后住院天数、术后排气时间、尿管留置时间、控尿训练的效果、切口愈合情况及美观度、术后随访患者满意度。结果:142例手术均在机器人辅助腹腔镜下顺利完成,无中转开放。经腹腔组与经腹膜外单孔两组手术切口护理切口感染3例(3.7%)、1例(1.7%),差异无统计学意义(P>0.05);引流管拔除时间分别为4.8(3~13)d和2.8(1~10)d,差异有统计学意义(P<0.05);术后疼痛评分分别为2.1(1~9)分和1.9(1~8)分,差异无统计学意义(P>0.05);术后住院天数分别为9.3(8.0~16.0)d和8.4(7.0~13.0)d,差异无统计学意义(P>0.05);术后排气时间分别为1.3(0.65~3.0)d和3.4(2.0~7.0)d,差异有统计学意义(P<0.05);术后尿管留置时间分别为9.0(7.0~21.0)d和6.0(4.0~8.0)d,差异有统计学意义(P<0.05);两组术后即刻、3个月、6个月尿控例数分别为8例(9.8%)、51例(62.2%)、62例(75.6%)和17例(28.3%)、43例(71.7%)、54例(90.0%),差异有统计学意义(P<0.05);两组总切口长度分别为12.1(10.4~13.4)cm和5.6(5.0~6.0)cm,差异有统计学意义(P<0.05);术后满意度分别为90%和100%,差异有统计学意义(P<0.05)。结论:机器人辅助腹腔镜腹膜外单孔前列腺癌根治术围手术期护理具有恢复时间更短、尿控缓解率更高、切口美观整洁、术后满意度更高的优势,更有利于术后护理工作的开展。

Comparative study on perioperative nursing in robotassisted laparoscopic transperitoneal and extraperitoneal single-site radical prostatectomy

Objective:To explore the perioperative nursing advantages of robot-assisted laparoscopic extraperitoneal single-site radical prostatectomy in treating prostate cancer by comparing with transperitoneal approach.Methods:A retrospective analysis was performed on 142 patients who received robot-assisted laparoscopic radical prostatectomy in Department of robotic Minimally Invasive Surgery Center of Sichuan Provincial People’s Hospital from July 2019 to June 2020,including 82 patients who received robot-assisted laparoscopic transperitoneal radical prostatectomy and 60 patients who underwent robot-assisted laparoscopic extraperitoneal single-site radical prostatectomy.All surgeries were performed by the same surgeon.Surgical incision nursing,drainage tube removing time,postoperative pain score,postoperative hospital stay,postoperative exhaust time,catheter indwelling time,effect of urinary continence training,incision healing and aesthetic degree,and patient satisfaction in postoperative follow-up between the two groups of patients were compared.Results:142 cases of surgery were successfully completed under robot-assisted laparoscopy with no conversion to open surgery.There were 3 cases(3.7%)of nursing incision infection in transperitoneal group and 1 case(1.7%)in extraperitoneal group,which was no significant difference(P>0.05).Removal time of drainage tube of the two groups were 4.8(3-13)d and 2.8(1-10)d respectively,and the difference was statistically significant(P<0.05).Postoperative pain scores of the two groups were 2.1(1-9)and 1.9(1-8)respectively,and the difference was not statistically significant(P>0.05).Postoperative hospital stay of the two groups were 9.3(8.0-16.0)d and 8.4(7.0-13.0)d respectively,and the difference was not statistically significant(P>0.05).Postoperative exhaust time were 1.3(0.65-3.0)d and 3.4(2.0-7.0)d respectively,and the difference was statistically significant(P<0.05).Postoperative catheter indwelling time were 9.0(7-21.0)d and 6.0(4.0-8.0)d respectively,and the difference was statistically significant(P<0.05).Urinary continence immediately,3 months and 6 months after operation of the transperitoneal group were 8 cases(9.8%),51 cases(62.2%),62 cases(75.6%)and 17 cases(28.3%),of the extraperitoneal group were 43 cases(71.7%)and 54 cases(90.0%)correspondingly,and the difference was statistically significant(P<0.05).The total incision length of the two groups were12.1(10.4-13.4)cm and 5.6(5.0-6.0)cm respectively,and the difference was statistically significant(P<0.05).Postoperative satisfaction of the two groups were 90%and 100%,the difference was statistically significant(P<0.05).Conclusion:The perioperative nursing of robot-assisted laparoscopic extraperitoneal single-site radical prostatectomy has shorter recovery time,higher urinary continence rate,more beautiful and clean incision and higher postoperative satisfaction,which is more conducive to postoperative nursing.