目的 对比Da Vinci机器人辅助腹腔镜前列腺癌根治术(RALRP)与耻骨后前列腺癌根治术(RRP)的围手术期临床资料, 初步评价机器人辅助前列腺癌根治术的价值。材料与方法 回顾本科2010年5月至2011年11月间同一组医生行RALRP 24例。观察手术时间、出血量、输血情况、术后病理等, 随访控尿等情况。与同期该组医生行RRP 38例相比较。结果进行统计学分析。结果 RALRP组平均手术时间为4.85小时(3.15~7.50小时), 其中前8例(RALRP1组)平均手术时间5.30±1.56小时, 后16例(RALRP2组)平均手术时间3.96±1.09小时;RRP组平均手术时间3.60±1.27小时。RALRP组出血量100~1 200 ml, 其中RALRP1组平均出血量625±220 ml, RALRP2组平均出血量155±103 ml, RRP组平均出血量655±270 ml。RALRP组输血率33.3%(7/24), 其中RALRP1组输血率75.0% (6/8), RALRP2组输血率12.5% (2/16), RRP组输血率42.1% (16/38)(P<0.01)。RALRP组术后1月控尿率优于RRP组:RALRP1组控尿率62.5% (5/8), RALRP2组控尿率81.3% (13/16), RRP组控尿率57.9% (22/38)。术后病理RALRP组切缘阳性率20.8%;RRP组切缘阳性率26.3%;平均住院时间RALRP组15天, RRP组21天(P<0.05)。结论 Da Vinci机器人辅助下前列腺癌根治术有较短的学习曲线, 对减少出血、避免输血、近期尿控等方面较RRP有更大的优势。但机器人手术是否具有远期优势仍需随访。
Objective To compare the perioperative clinical statistics between Robotic-assistant Laparoscopic Radical Prostatectomy (RALRP) and Retropubic Radical Prostatectomy (RRP).Methods We retrospectively review the 24 cases who accepted RALRP in our center from May 2010 to November 2011.The total operative time,blood loss,transfusion rate,the pathological outcome,urinary continence outcome etc were analyzed,and were compared with the data of 38 cases which underwent RRP accomplished by the same doctors in the same period.Results The mean operative time was 4.85 hours (3.15~7.5hours) in RALRP group and 3.60±1.27 hours in RRP group.In the RALRP group,the mean operative time of the earlier 8 cases (RALRP1 group) and later 16 cases (RALRP2 group) was respectively 5.30±1.56 and 3.96±1.09 hours.The blood loss in RALRP was 100~1 200 ml,and the mean blood loss in RALRP1 and RALRP2 was 625±200 ml and 155±103 ml.In RRP group,the mean blood loss was 655±270 ml.The blood transfusion rate in RALRP and RRP was 33.3 % (7/24) and 42.1 % (16/38).The blood transfusion rate in RALRP1 and RALRP2 was 75 % (6/8) and 12.5 % (2/16) (P<0.01).The continence rate at 1 month after surgery was better in RALRP than in RRP group.The rate was respectively 62.5 % (5/8) and 81.3 % (13/16) in RALRP1 and RALRP2,and 57.9 % (22/38) in RRP.The overall margin positivity rate was respectively 20.8% and 26.3% in RALRP and RRP group.The mean hospital stay was 15 days and 21 days in RALRP and RRP group.Conclusions RALRP has a short learning curve for urologists,which has more advantage in decreasing blood loss,avoiding blood transfusion,recovering continence etc compared with RPP.However,whether RALRP has long-term advantages still needs long-time follow-up.
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