机器人辅助腹腔镜下根治性前列腺切除术与开放手术的对照研究
Comparative study on the efficacy and safety of robot assisted laparoscopic and retropubic radical prostatectomy
目的 分析机器人辅助腹腔镜下根治性前列腺切除术(robot assisted laparoscopic radical prostatectomy,RALRP)与耻骨后根治性前列腺切除术(retropubic radical prostatectomy,RRP)治疗局限性前列腺癌的疗效和安全性.方法 回顾性分析2004年5月至2013年9月接受RALRP或RRP并获得随访的124例患者临床资料,其中RALRP组41例,RRP组83例.两组患者年龄、PSA、术前分期和Gleason评分比较差异均无统计学意义(P>0.05).比较两种术式的手术时间、术中出血量及输血比例、术后病理、术后留置导尿时间、住院天数、尿控、生化复发率等指标.结果 124例手术均获成功,RALRP组无中转开放.RALRP组与RRP组平均手术时间分别为224、165 min,平均术中出血量分别为266、659 ml,术中输血8例(20%)和71例(86%),术后住院时间分别为16.4、17.9d,切缘阳性率分别为24%与10%,组间比较差异均有统计学意义(P<0.05).RALRP组与RRP组术后留置导尿时间分别为27.2、23.5 d,组间比较差异无统计学意义(P>0.05).RALRP组术后3个月、6个月、1年、2年控尿率分别为56%、70%、80%、94%,RRP组分别为55%、70%、78%、79%;RALRP组术后6个月、1年、2年生化复发率分别为8%、21%、24%,RRP组分别为13%、16%、31%;两组间比较差异均无统计学意义(P>0.05).结论 RALRP具有出血少、恢复快的优势.由于我院RALRP尚处于学习曲线内,手术时间长于RRP,手术切缘阳性率高于RRP组,但术后短期肿瘤学效果、控尿功能方面与RRP相似.
更多Objective To compare the efficacy and safety of robot assisted laparoscopic radical prostatectomy (RALRP) and retropubic radical prostatectomy (RRP).Methods From May 2004 to September 2013,data from 124 prostate cancer patients were collected.Of them,41 cases underwent RALRP,and 83 cases underwent RRP.The following clinical data was reviewed and analyzed,including operation time,blood loss,transfusion rate,duration of catheterization,time of postoperative hospital stay,postoperative pathology,continence and biochemical recurrence.Results All the operations were successfully performed,without RALRP converted to open surgery.The mean operation time of the RALRP group and the RRP group was 224 min and 165 min,mean blood loss was 266 ml and 659 ml,the transfusion rates were 20% and 86%,the mean postoperative hospital stay was 16.4 d and 17.9 d,the positive margin rates were 24% and 10%,the differences were significant (P < 0.05).The mean catheterization time was 27.2 d and 23.5 d (P > 0.05).The 6-month,1-year and 2-year biochemical recurrence rates were 8%,21% and 24% in RALRP group,and 13%,16%,31% in RRP group.The 3-month,6-month,1-year and 2-year continence rates were 56%,70%,80% and 94% in RALRP group,and 55%,70%,78% and 79% in RRP group.For biochemical recurrence and continence rates,there was no significant difference between the 2 groups.Conclusions RALRP possesses advantages of less bleeding and faster recovery.In addition,the effect of postoperative oncology and continence is similar to open surgery.
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