目的:探讨日间手术模式下机器人辅助腹腔镜Madigan前列腺切除术治疗良性前列腺增生(benign prostatic hyperplasia,BPH)的有效性和安全性.方法:回顾性分析2022年9月1日-2023年12月31日上海交通大学医学院附属第九人民医院收治的42例BPH患者的临床资料.42例患者均行日间手术模式下机器人辅助腹腔镜Madigan前列腺切除术,收集并分析患者一般资料和围手术期指标,并完成3个月随访,观察患者术后前列腺体积、国际前列腺症状评分(international prostate symptom score,IPSS)、生活质量评分(quality of life,QoL)、最大尿流率(maximum flow rate,Qmax)、残余尿(post-void residual urine,PVR)、国际勃起功能指数-5(in-ternational index of erectile function-5,IIEF-5)、前列腺特异性抗原(prostate specific antigen,PSA)及并发症情况.结果:42例BPH患者均顺利完成手术.所有患者均于术后第1天出院.术后3个月随访结果显示:前列腺体积32～55 mL,平均(45.3±10.1)mL;IPSS 1～10 分,平均(6.4±2.3)分;QoL 0～3 分,平均(1.8±0.9)分;Qmax 14～30 mL/s,平均(21.5±6.3)mL/s;PVR 0～30 mL,平均(10.2±13.7)mL;IIEF-5 20～24 分,平均(22.1±1.3)分;PSA 0.6～2.3 ng/mL,平均(1.4±0.6)ng/mL;与术前比较,差异均有统计学意义(P＜0.05).并发症方面,2例患者拔管后轻度漏尿,提肛训练2周后完全恢复;3例患者术后轻度血尿,1周后恢复;所有患者均无真性尿失禁、尿道狭窄、勃起功能障碍及逆行射精等情况发生.Clavien-Dindo分级Ⅰ级并发症2例(4.8％);Ⅱ级并发症3例(7.1％);无Ⅲ、Ⅳ级并发症发生.结论:日间手术模式下机器人辅助腹腔镜Madigan前列腺切除术治疗BPH安全、有效,术后恢复快,排尿症状改善明显,尿道完整性高,术后尿道狭窄、逆行射精的并发症发生率低.
Robot-assisted laparoscopic Madigan resection of prostate in daytime operation mode for the treatment of benign prostatic hyperplasia
Objective:To explore the effectiveness and safety of robot-assisted laparoscopic Madigan resection of prostate to treat benign prostatic hyperplasia(BPH)in daytime operation mode.Methods:The clinical data of 42 patients with BPH admitted to Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine from September 1st,2022 to December 31st,2023 were analyzed retrospectively.All 42 patients under-went robot-assisted laparoscopic Madigan resection of the prostate under daytime operation mode.General data and perioperative indicators of the patients were collected and analyzed,and a 3-month follow-up was completed to observe the prostate volume,international prostate symptom score(IPSS),quality of life(QoL),maximum flow rate(Qmax),post-void residual urine(PVR),international index of erectile function-5(IIEF-5),prostate specific antigen(PSA)and complications of the patients after operation.Results:All 42 patients with BPH were success-fully completed the operation.All patients were discharged on the first day after operation.The follow-up results at 3 months after surgery showed that the prostate volume(45.3±10.1)mL,IPSS(6.4±2.3)score,QoL(1.8±0.9)score,Qmax(21.5±6.3)mL/s,PVR(10.2±13.7)mL,IIEF-5(22.1±1.3)score,and PSA(1.4±0.6)ng/mL were all significantly improved(all P＜0.001).In terms of complications,two patients had mild stress urinary incontinence after removing the catheter and fully recovered with anal lift for two weeks.Three pa-tients had mild postoperative hematuria,which recovered one week later.All patients did not experience true uri-nary incontinence,urethral stricture,erectile dysfunction,or retrograde ejaculation.Clavien-Dindo grade Ⅰ com-plications were found in 2 cases(4.8％),and Grade Ⅱ complications in 3 cases(7.1％).No grade Ⅲ or Ⅳ com-plications occurred.Conclusion:Robot-assisted laparoscopic Madigan resection of the prostate in daytime operation mode is safe and effective in the treatment of BPH,with rapid postoperative recovery,obvious improvement of u-rination symptoms,high urethral integrity.The incidence of complications such as postoperative urethral stricture and retrograde ejaculation is low.
prostatectomyrobot surgery systemdaytime operation
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