CAJ | 학술논문

目的总结机器人辅助腹腔镜下根治性前列腺切除术的手术经验和初期随访结果,评估该术式的安全性及有效性. 方法 2012年3月至2013年11月收治的前列腺癌患者107例,年龄49～80岁,平均67岁.术前PSA 3.6～209.0 μg/L,平均23.6 μg/L.术前Gleason评分5～10分,平均7.4分.术前肿瘤临床分期T1aN0M0～T3aN0M0期,其中≤T1c期6例,T2a期10例,T2b期46例,T2c期39例,T3a期6例.全麻下行机器人辅助腹腔镜下根治性前列腺切除术,其中经腹腔途径102例,经腹膜外途径5例.术后随访患者血清PSA变化及尿控情况. 结果本组中106例手术顺利完成,1例因前列腺与直肠粘连严重中转开放手术.机器人术前准备时间28～ 106 min,平均52 min;手术时间118～462 min,平均182 min;术中出血量50～1 300 ml,平均232 ml,术中输血5例;术后2～4d下床活动,7～14d拔除导尿管.术后住院天数5～20 d,平均11d.术后病理诊断均为前列腺腺癌,病理分期为pT2aN0M0～ pT3bN1M0期,切缘阳性率为15％(16/107),7例精囊侵犯,2例闭孔淋巴结转移.术后Gleason评分6～10分,平均7.4分.术后4周复查9例血清PSA＞0.2μg/L.107例术后随访1～19个月,平均6个月.术后3、6个月尿控恢复率分别为87％(71/82)和92％ (36/39). 结论机器人辅助腹腔镜下根治性前列腺切除术具有术中失血少、住院时间短、控尿恢复快的优点,治疗临床局限性前列腺癌安全、有效.
목적 총결궤기인보조복강경하근치성전렬선절제술적수술경험화초기수방결과,평고해술식적안전성급유효성. 방법 2012년3월지2013년11월수치적전렬선암환자107례,년령49～80세,평균67세.술전PSA 3.6～209.0 μg/L,평균23.6 μg/L.술전Gleason평분5～10분,평균7.4분.술전종류림상분기T1aN0M0～T3aN0M0기,기중≤T1c기6례,T2a기10례,T2b기46례,T2c기39례,T3a기6례.전마하행궤기인보조복강경하근치성전렬선절제술,기중경복강도경102례,경복막외도경5례.술후수방환자혈청PSA변화급뇨공정황. 결과 본조중106례수술순리완성,1례인전렬선여직장점련엄중중전개방수술.궤기인술전준비시간28～ 106 min,평균52 min;수술시간118～462 min,평균182 min;술중출혈량50～1 300 ml,평균232 ml,술중수혈5례;술후2～4d하상활동,7～14d발제도뇨관.술후주원천수5～20 d,평균11d.술후병리진단균위전렬선선암,병리분기위pT2aN0M0～ pT3bN1M0기,절연양성솔위15％(16/107),7례정낭침범,2례폐공림파결전이.술후Gleason평분6～10분,평균7.4분.술후4주복사9례혈청PSA＞0.2μg/L.107례술후수방1～19개월,평균6개월.술후3、6개월뇨공회복솔분별위87％(71/82)화92％ (36/39). 결론 궤기인보조복강경하근치성전렬선절제술구유술중실혈소、주원시간단、공뇨회복쾌적우점,치료림상국한성전렬선암안전、유효.
Objective To summarize our initial experience and early postoperative follow-up results with robot assisted laparoscopic radical prostatectomy (RALP) and evaluate the efficacy and safety of this surgical method.Methods 107 patients underwent RALP in our hospital from March 2012 to November 2013.The mean age of the patients was 67 years (range,49-80 years),The mean pretreatment serum PSA level was 23.6 μg/L(range,3.6-209.0 μg/L),and mean preoperative Gleason score was 7.4 (range,5-10).Clinical stages were between T1aN0M0-T3aN0M0,which ≤＜ T3c in 6 cases,T2a in 10 cases,T2b in 46 patients,T2c in 39 cases,T3a in 6 cases.Under the general anesthesia,all patients received RALP.Among them,transperitoneal approach was chosen in 102 patients and extraperitoneal approach was chosen in 5 patients.The level of serum PSA and urinary continence were followed up after procedure.Results Except one patient converted to open surgery due to the serious adhesion between prostate and rectum,the remaining 106 cases are performed successfully.The mean preoperative set up time of the robot was 52 min (range,28-106 min),and mean operation time was 182 min (range,118-462 min).The perioperative blood loss averaged 232 ml (range,50～ 1 300 ml),and 5 patients required blood transfusion ; The patients were ambulant between the 2nd and 4th postoperative days.Foley catheter was successfully removed on day 7 to 14 and mean hospital stay after surgery was 11 days (range,5-20 d).Postoperative pathology was prostatic adenocarcinoma in all patients.Pathological stages were between pT2aN0M0-pT3b N1 M0.Positive margin rate was 15％ (16/107).Seminal vesicle invasion was found in 7 patients and obturator lymph node metastasis was observed in 2 patients.The mean postperative Gleason score was 7.4 (range,6-10).During a median follow-up of 6 (range,1-19) months,the level of serum PSA was more than 0.2 μg/L in 9 patients 4 weeks after RALP.After 3 and 6 months,the urinary continence recovery rates were 87％ (71/82) and 92％ (36/ 39),respectively.Conclusions RALP showed significantly advantages,such as low perioperative blood loss,short hospital stay and fast continence recovery.Therefore,RALP is a feasible and safe technique for patients with localized prostate cancer.