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目的探讨机器人辅助下前列腺癌根治术中尿道分离的技巧。方法通过对尿道周围解剖结构的研究和手术视频的回顾,总结“双三明治”式尿道分离方法,并归纳出6个手术操作要点:找准“黄金眼”、扎紧静脉丛、斜坡入路、持续张力、两翼松解、下底掏空。2013年6月至9月,采用“双三明治”式尿道分离方法,单术者完成20例机器人辅助下前列腺癌根治术,其中T2N0M014例,T3N0M03例,T4N0M03例(新辅助治疗3个月)。结果手术均顺利完成,无中转开放,平均手术时间(138±47.8)min,出血(150±67.4)mL,膀胱尿道吻合时间(13±6.5)min。利用“双三明治”式尿道分离法,成功解剖性游离尿道17例。失败3例中,2例系尖部粘连,解剖层次不清;1例因出血较多,影响视野。完整保留尿道的患者术后(拔导尿管1d)控尿率64.7%(11/17),尖部切缘阳性11.8%(2/17),进一步随访仍在进行中。结论在达芬奇机器人系统的辅助下,采用“双三明治”式尿道分离方法,可解剖性游离尖部尿道,降低膀胱尿道吻合难度。
Objective To explore the technique of robot-assisted urethral separation in radical prostatectomy. Methods Through the study of the anatomy of the urethra and the review of the video of the surgery, the method of “double sandwich” urethral separation was summarized and the main points of the six surgical operations were summarized: pinpointing the “golden eye”, clamping the venous plexus, Into the road, sustained tension, two wings loosening, the bottom emptied. From June to September 2013, 20 patients underwent robot-assisted radical prostatectomy with “double sandwich” urethral isolation, including T2N0M014 cases, T3N0M03 cases and T4N0M03 cases (neoadjuvant therapy for 3 months ). Results The operation was successfully completed. The mean operative time was (138 ± 47.8) min, hemorrhage (150 ± 67.4) mL, and bladder and urethra anastomosis time were (13 ± 6.5) min. The use of “double sandwich ” urethral separation method, the successful dissection of 17 cases of free urethra. Three cases failed, 2 cases of Department of Department of apex adhesions, anatomical level is unclear; 1 case due to more bleeding, affecting vision. Patients with intact urethra had a controllable ulcer rate of 64.7% (11/17) and a positive edge of 11.8% (2/17) after operation, with further follow-up still underway. Conclusion With the aid of the Da Vinci robot system, the “double sandwich” urethral separation method can dissect the tip urethra and reduce the difficulty of urinary bladder anastomosis.