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目的总结21例行机器人辅助筋膜内前列腺癌根治术的患者资料,探讨该方法对患者术后尿控功能的影响。方法 2012年4月至2014年10月,长海医院单一术者实施机器人辅助的腹腔镜下前列腺癌根治术100例,其中筋膜内前列腺癌根治术21例,21例中4例在前列腺切除术后行盆内筋膜重建。4例患者术前临床分期均低于T2期,平均PSA为11.1 ng/ml。在成功进行双侧筋膜内前列腺切除术后,应用尿道吻合剩余的倒刺线,自尿道吻合位置,将两侧剩余的盆内筋膜缝合,使膀胱颈口在两侧的盆内筋膜的挤压下形成一定长度的功能性尿道。结果患者术中出血量50~600 ml,平均260 ml,术中输血1例,术后14 d拔除导尿管。术后住院天数为6~19 d,平均9 d。术后病理切缘阳性5例,其中4例为尖部阳性,包膜侵犯2例,精囊腺侵犯1例。术后4周血清PSA>0.2 ng/ml 2例,<0.2 ng/ml 19例。随访1~22个月,平均随访时间12.4个月。本组21例,术后2周拔管排尿可控6例,术后1个月、3个月尿控有效率(以每天应用尿垫≤1块为标准)分别为61.9%(13/21)和90.5%(19/21)。结论选择肿瘤分期较早的患者,掌握一定的操作技巧,机器人辅助筋膜内前列腺癌根治术可提高患者术后尿控。
Objective To summarize the data of 21 cases of robotic-assisted radical prostatectomy for prostatectomy and investigate the effect of this method on postoperative urinary control. Methods From April 2012 to October 2014, 100 cases of robotic assisted laparoscopic radical prostatectomy were performed in Changhai Hospital. Among them, 21 cases were treated with radical prostatectomy in the fascia and 4 cases were treated with prostatectomy Posterior pelvic fascia reconstruction. All the 4 patients had preoperative clinical staging below T2, with an average PSA of 11.1 ng / ml. In the successful bilateral fascia resection, the application of urethral anastomosis of the remaining barbed wire, urethral anastomosis from the location of the remaining sides of the pelvic fascia sutured, the bladder neck in both sides of the pelvic fascia The formation of a certain length of functional urethra under extrusion. Results The intraoperative blood loss of 50 ~ 600 ml, an average of 260 ml, 1 case of intraoperative blood transfusion, 14 days after removal of the catheter. The postoperative hospital stay was 6-19 days with an average of 9 days. There were 5 cases with positive margins of pathology, of which 4 cases were positive for spikes, 2 cases were encircled by capsule, and 1 case was infiltrated by seminal vesicle. Four weeks after operation, serum PSA> 0.2 ng / ml in 2 cases and <0.2 ng / ml in 19 cases. Followed up for 1 to 22 months, the average follow-up time was 12.4 months. The group of 21 cases, 2 weeks after surgery extubation controllable urination in 6 cases, 1 month after surgery, 3 months urinary control efficiency (daily urinary pad ≤ 1 block as the standard) were 61.9% (13/21 ) And 90.5% (19/21). Conclusion Selecting patients with earlier tumor stage and mastering some operation skills, robotic-assisted radical prostatectomy can improve postoperative urinary control.