保留Retzius间隙的机器人辅助根治性前列腺切除术在中叶突出患者中的优势#br#

目的研究保留Retzius间隙的机器人辅助根治性前列腺切除术（RS-RARP）对显著中叶突出（PML）患者的疗效。方法收集2017年7月至2019年12月于南京大学附属鼓楼医院行传统机器人辅助根治性前列腺切除术（RARP）和RS-RARP的患者资料，并比较了两组患者的基本情况，围手术期结果以及短期肿瘤学和尿控结局。结果共78例患者入组，其中39例接受了传统的RARP，39例接受了RS-RARP。 RS-RARP组的操作时间较短（P＜0.05）。两组患者的总切缘阳性率及基底部切缘阳性率差异无统计学意义（P＞0.05）。在12个月的随访时间中，两组患者的生化复发率差异无统计学意义（P＞0.05），尿失禁恢复率差异有统计学意义（P＜0.05）。结论RS-RARP治疗显著PML患者，具有更短的操作时间及更好的尿控结果，值得临床推广应用。

The advantage of Retzius-sparing robot-assisted radical prostatectomy in patients with protruded median lobe

Objective: To investigate the effect of protruded median lobe (PML) among patients underwent Retzius-sparing robot-assisted radical prostatectomy (RS-RARP). Methods: Patients who had undergone traditional RARP or RS-RARP in Affiliated Drum Tower hospital, Medical School of Nanjing University during July 2017 to December 2019 were collected. The basic information, perioperative outcomes, short-term oncological, and UC outcomes were compared among the two groups. Results: 78 patients who had undergone RARP were included in our study. 39 patients underwent traditional RARP and the other underwent RS-RARP. The age, PSA and PV showed no obvious difference during two groups (P= 0.883, 0.586, 0.076). Perioperative characteristics including estimated blood loss, nerve sparing, complications and length of stay were not statistically different among the three groups (P= 0.943, 0.361, 0.209, 0.233, respectively). Console time of RS-RARP were shorter and statistically different(P= 0.036). The rate of positive surgical margin (PSM) and positive surgical margin at base (PSMB) were not significantly different in the two groups (P= 0.151, 0.395). Comparison between the two approaches showed better recovery of UC (HR = 1.885，95％CI：1.136-3.128，log-rank P= 0.002) and similar biochemical recurrence (log-rank P= 0.079) after RS-RARP. Conclusion: Compared with the traditional approach, RS-RARP offers better UC outcome and shorter console time for patients with significant PML under the similar oncological outcome.