CAJ | 학술논문

目的：总结单术者最初100例机器人辅助腹腔镜下根治性前列腺切除术（ robotic-assisted laparoscopic radical prostatectomy ，RALRP）患者的临床资料，探讨术者快速度过RALRP学习曲线的经验。方法回顾性收集我院2012年6月至2014年11月单术者最初100例RALRP患者的临床资料。年龄50～87岁，平均67岁。前列腺特异性抗原（PSA）1．3～214．0μg／L，平均值20．3μg／L。临床分期T1a～T2b期89例，T2c期4例，T3a ～T4期7例。低危患者16例，中危患者37例，高危患者47例。采用移动平均法对手术时间和术中出血量进行学习曲线分析。结果100例均顺利完成，无中转开放手术者。手术时间120～480 min，平均221 min（包括机械臂放置时间）。术中出血量50～800 ml，平均207 ml，术中输血2例。切缘阳性26例（26％）。术后3个月尿控恢复（尿垫使用≤1块）80例（89％）；另10例随访不足3个月，其中5例尿控恢复。对手术时间和术中出血量的分析提示，85～90例后进入比较稳定的时期。结论 RALRP学习曲线短，即便处于学习初期，患者总体治疗效果仍较好。
목적：총결단술자최초100례궤기인보조복강경하근치성전렬선절제술（ robotic-assisted laparoscopic radical prostatectomy ，RALRP）환자적림상자료，탐토술자쾌속도과RALRP학습곡선적경험。방법회고성수집아원2012년6월지2014년11월단술자최초100례RALRP환자적림상자료。년령50～87세，평균67세。전렬선특이성항원（PSA）1．3～214．0μg／L，평균치20．3μg／L。림상분기T1a～T2b기89례，T2c기4례，T3a ～T4기7례。저위환자16례，중위환자37례，고위환자47례。채용이동평균법대수술시간화술중출혈량진행학습곡선분석。결과100례균순리완성，무중전개방수술자。수술시간120～480 min，평균221 min（포괄궤계비방치시간）。술중출혈량50～800 ml，평균207 ml，술중수혈2례。절연양성26례（26％）。술후3개월뇨공회복（뇨점사용≤1괴）80례（89％）；령10례수방불족3개월，기중5례뇨공회복。대수술시간화술중출혈량적분석제시，85～90례후진입비교은정적시기。결론 RALRP학습곡선단，즉편처우학습초기，환자총체치료효과잉교호。
Objective To review the clinical data of the first 100 consecutive robotic-assisted laparoscopic radical prostatectomy ( RALRP) performed by a single surgeon , and to provide our experience in passing the learning curve of RALRP .Methods The retrospective study enrolled 100 consecutive patients diagnosed with prostate cancer from June 2012 to November 2014, who had undertaken RALRP , performed by Prof.Gao Xu.The patients aged 67 (50 to 87) years, with a mean PSA level of 20.3 (1.3 to 214.0)μg/L, among which 89 had a clinical staging of T1a to T2b, 4 staged T2c, and 7 staged T3a to T4.Of the patients, 16, 37, and 47 patients were categorized as low , intermediate, and high risk level , respectively. The operation time and blood loss volume were analyzed by moving average method .Results RALRP in all 100 cases were carried out successfully , with no conversion to open prostatectomy .The mean operation time was 221 (120 to 480) min, with an average intraoperative blood loss of 207 (50 to 800) ml; 2 cases received blood transfusion.Positive surgical margin rate was 26%.Eighty (89%) of 90 cases had recovery of continence ( equal to or less than 1 pad used daily ) 3 months postoperatively;10 cases had a follow-up time less than 3 months, and 5 had gained recovery of continence .The operation time and blood loss volume were stable at the 85th -90th case.Conclusion RALRP has a short learning curve , with a promising overall treatment outcome in the early phase of learning .