机器人辅助前列腺癌根治术治疗大体积前列腺癌的临床应用研究

目的:评估大体积前列腺癌行机器人辅助前列腺癌根治术（RALP）的疗效和安全性，探讨前列腺体积对手术难度的影响。方法:回顾性分析2013年1月至 2017年3月应用机器人辅助前列腺癌根治术治疗大体积前列腺癌35例患者临床资料（前列腺体积≥100 ml），tPSA水平为6.5~58.5 ng/ml，平均（19.5±8.7） ng/ml，Gleason评分≤6分4例，7分19例（3+4分8例，4+3分11例），8分7例，9~10分5例。3例有经尿道前列腺电切手术史，5例术前行新辅助内分泌治疗。手术方式均采用经腹膜内入路机器人辅助腹腔镜前列腺癌根治术，高危患者同时行扩大盆腔淋巴结清扫并术后辅助内分泌治疗12~18个月。结果:35例患者均顺利完成手术，无中转开放、直肠损伤及输血病例。手术时间为86~191 min，平均（154±19.8） min；术中出血量45~330 ml，平均（132±60.5） ml；住院时间5~9 d，平均（6.5±0.8） d。术后病理切缘阳性3例（8.6%）；盆腔淋巴结阳性2例（5.7%）。术后漏尿1例，术后2周停止。1例吻合口狭窄，经尿道扩张后排尿通畅。术后1~12个月复查，无生化复发病例，术后3个月有不同程度尿失禁9例（25.7%），1年内控尿满意33例（94.3%）。结论:大体积前列腺癌手术难度明显增大，需在具备丰富手术经验的前提下完成，采取合理的技术优化可以明显降低手术难度。

Clinical study of robot-assisted laparoscopic radical prostatectomy for prostate cancer patients with large prostate glands

Objective:To assess the efficiency and safety of robot-assisted laparoscopic radical prostatectomy (RALP) for prostate cancer patients with large prostate glands.Methods:The clinical data of 35 prostate cancer patients with large prostate glands (the volume of prostate≥100 ml) receiving RALP from January 2013 to March 2017 in our department were collected and retrospectively analyzed.Results:All the 35 cases were operated successfully.There was no open conversion，rectal injury and no blood transfusion.The average blood loss was (132±60.5) ml (range，45~330 ml).Average operative time was (154±19.8) min (range，86~191 min)，and the average postoperative hospital stay was (6.5±0.8) days (range，5~9 d).There were 3 cases of positive pathological margin (8.6%)，2 cases of positive lymph nodes (5.7%).There was one case of urine leak which was cured in 2 weeks after operation.One patient had anastomotic stricture.After urethral dilatation，the urine was unobstructed.The tPSA of all patients were less than 0.2 ng/ml during follow-up of one to twelve months.There were 9 cases (25.7%) with urinary incontinence in different degrees in 3 months after operation.The continence rate was 94.3% within 1 year.Conclusion:Through reasonable technical optimization，the operation difficulty can be obviously reduced.