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目的:探讨机器人辅助腹腔镜根治性前列腺切除术(RALRP)在治疗高危前列腺癌中的价值,总结其临床经验。方法:回顾性分析2013年2月~2015年10月采用RALRP治疗86例高危前列腺癌患者的临床资料:平均年龄(67.3±10.5)岁。术前检查单独PSA>20ng/ml者19例,单独Gleason评分≥8分9例,PSA>20ng/ml并Gleason评分≥8分者58例;术前诊断为T_3期者9例。手术方式均采用经腹膜内路径机器人辅助腹腔镜根治性前列腺切除术,同时行盆腔淋巴结清扫。结果:本组均顺利完成机器人手术,无中转开放手术者。平均手术时间(146±45)min,平均出血量(95±53)ml,术后住院时间为(7.3±2.5)d。术后6例拔管后出现尿失禁,于1周~3个月恢复控尿;术后3例漏尿,2例淋巴漏。术后病理检查显示淋巴结阳性7例;切缘阳性4例,术后控尿恢复后给予局部放射治疗。结论:对于高危前列腺癌患者,采用以RALRP为核心的综合治疗策略是安全有效的。
Objective: To investigate the value of robot assisted laparoscopic radical prostatectomy (RALRP) in the treatment of high-risk prostate cancer and to summarize its clinical experience. Methods: The clinical data of 86 high-risk prostate cancer patients treated with RALRP from February 2013 to October 2015 were retrospectively analyzed. The mean age was 67.3 ± 10.5 years. Preoperative examination of PSA alone> 20ng / ml in 19 cases, alone Gleason score ≥ 8 points in 9 cases, PSA> 20ng / ml and Gleason score ≥ 8 points in 58 cases; preoperative diagnosis of T_3 were 9 cases. Surgical methods are used by the intraperitoneal route robot assisted laparoscopic radical prostatectomy, while the pelvic lymph node dissection. Results: All the patients in this group successfully completed the robotic surgery without any transfer of open surgery. The average operation time was (146 ± 45) min and the mean amount of bleeding was (95 ± 53) ml. The postoperative hospital stay was (7.3 ± 2.5) days. Postoperative urinary incontinence occurred in 6 cases after extubation, and urine control was restored in 1 week to 3 months. Three cases had leakage of urine and two cases of lymph leakage after operation. Pathological examination showed positive lymph nodes in 7 cases; positive margins in 4 cases, postoperative urinary control after giving local radiotherapy. Conclusion: It is safe and effective to adopt a comprehensive treatment strategy with RALRP as the core of high-risk prostate cancer patients.