目的:探讨前列腺中叶突出的前列腺癌患者行机器人辅助保留Retzius间隙前列腺根治术(Retzius-sparing robot-assisted radical prostatectomy,RsRARP)的安全性及可行性,分析围手术期结果.方法:回顾性分析2023年1月-2023年6月在解放军总医院第三医学中心行RsRARP的患者资料,通过术前影像学资料筛选出中叶突入膀胱≥2.0 cm的患者共12例,进行为期3个月的随访.患者中位年龄为68岁,中位体重指数(body mass index,BMI)为 24.9 kg/m2.术前总前列腺特异性抗原(total prostate specific antigen,tPSA)中位数为9.0 μg/L,游离 PSA(free postate specific antigen,fPSA)中位数为 1.375 μg/L.穿刺总阳性针数中位数为 2.5针,活检Gleason评分6分2例,8分2例,9分4例.临床TNM分期cT1c期2例,cT2a期8例,cT3b期2例.所有患者术前控尿均正常,国际勃起功能指数问卷表-5(International Index of Erectile Function5,IIEF-5)评分均小于7分.术后6周开始复查血清PSA,之后每3个月复查1次,记录术后1、2、3个月时控尿及勃起功能情况.结果:12例手术均顺利完成,无中转开放患者,无输血患者,无严重术中、术后并发症发生.所有患者均采用未保留勃起神经的筋膜外技术,2例术前活检提示9分的患者在术中进行了淋巴结清扫,中位手术时长(从建立气腹到缝合皮肤切口)为125.0 min,中位出血量为50 mL.术后病理示无包膜外及淋巴结转移,切缘阳性率为16.7％,pT2a 期 4 例,pT2b 期 2 例,pT2c 期 6 例.Gleason 评分 3+4=7 分2 例,4+3=7 分6例,4+5=9 分 4例.所有患者术后均成功拔除尿管,拔除时长中位数为14 d,术后3个月tPSA中位数为0.009 μg/L,且所有患者均小于0.060 μg/L,未观察到生化复发.所有患者术后3个月均无勃起功能.术后1个月尿控率为33.3％,2个月尿控率为66.7％,3个月尿控率为83.3％.结论:对于熟练掌握RsRARP的术者来说,RsRARP在治疗中叶突出的pT2期及以下前列腺癌患者时,对肿瘤控制和术后尿控相关解剖结构的保护效果较为理想,无严重并发症,出血量和手术时长较为可控.然而,仍需要进行大样本、长期随访研究以进一步探索和验证.
Retzius-sparing robot-assisted radical prostatectomyin 12 cases of prostate cancer with prominent median lobe
Objective:To investigate the safety and feasibility of Retzius-sparing robot-assisted radical prostatectomy(RsRARP)for prostate cancer patients with prominent median lobe,and to analyze the perioperative outcomes.Methods:A retrospective analysis was conducted on patients who underwent RsRARP at our center from January 2023 to June 2023.A total of 12 patients with median lobe protrusion into the bladder ≥2.0 cm were selected through preoperative imaging data andthree-month follow-up.The median age of the patients was 68 years,and the median body mass index(BMI)was 24.9 kg/m2.The median preoperative total prostate specific antigen(tPSA)was 9.0 μg/L,and the median free postate specific antigen(fPSA)was 1.375 μg/L.The median number of positive biopsy cores was 2.5.The Gleason score was 6 in 2 cases,8 in 2 cases,and 9 in 4 cases.The clinical TNM stage was cT1c in 2 cases,cT2a in 8 cases,and cT3b in 2 cases.All patients had normal preoperative urinary continence and an International Index of Erectile Function5(IIEF-5)score of less than 7.Serum PSA was reviewed starting at 6 weeks postoperatively and then every three months.Urinary continence and erectile function were recorded at 1,2,and 3 months postoperatively.Results:All 12 surgeries were successfully completed without conversion to open surgery,blood transfusion,or serious intraoperative and postop-erative complications.All patients underwent extrafascial technique without preserving erectile nerves.Lymph node dis-section was performed in 2 cases with a preoperative biopsy suggesting a Gleason score of 9.The median operative time(from skin to skin)was 125.0 minutes,and the median blood loss was 50 mL.Postoperative pathology showed no ext-racapsular or lymph node metastasis.The positive margin rate was 16.7％.According to the pT stage,there were 4 ca-ses of pT2a,2 cases of pT2b,and 6 cases of pT2c.The Gleason score was 3+4=7 in 2 cases,4+3=7 in 6 cases,and 4+5=9 in 4 cases.All patients successfully had their urinary catheters removed postoperatively,with a median removal time of 14 days.The median tPSA at three months postoperatively was 0.009 μg/L,and all patients had a value less than 0.060 μg/L,indicating no biochemical recurrence.No patients had erectile function at three months postoperatively.The urinary continence rate was 33.3％at one month,66.7％at two months,and 83.3％at three months postopera-tively.Conclusion:For surgeons proficient in RsRARP,this technique demonstrates ideal tumor control and protection of urinary continence-related anatomical structures when treating pT2 or lower-grade prostate cancer patients with prominent median lobe.It is associated with low complication rates and controllable blood loss and operative time.However,further exploration and validation through large-sample,long-term follow-up studies are still warranted.
Retzius-sparing robot-assisted radical prostatectomyprostate cancerprominent median lobe
万方数据
维普
