摘要目的 探讨高危前列腺癌患者行机器人辅助腹腔镜下根治性前列腺切除术的近期治疗效果.方法 回顾性分析2012年3月至2017年3月我院400例采用机器人辅助腹腔镜下根治性前列腺切除术治疗的高危前列腺癌患者的临床资料.年龄49 ～ 83岁,中位年龄68岁.术前PSA5.2 ～999.0 ng/ml,中位值23.1 ng/ml.采用Logistic回归分析术后病理切缘阳性的危险因素.结果 400例手术均顺利完成,其中经腹腔入路384例,经腹膜外入路16例.手术时间50 ～ 555 min,中位时间115 min;术中出血量30～ 500 ml,中位出血量110ml.围手术期并发症6例,2例直肠损伤,2例出现心脑血管并发症,2例术中大出血,无围手术期死亡病例.术后病理检查结果示151例(37.8％)切缘阳性.345例(86.3％)行淋巴结清扫术,其中253例(73.3％)行闭孔淋巴结清扫术,92例(26.7％)行扩大淋巴结清扫术.淋巴结清扫个数为3 ～ 36个,中位数9个.80例(23.2％,80/345)淋巴结阳性.回归分析结果显示术前PSA＞ 20 ng/ ml和临床分期≥T2.期是切缘阳性的危险因素.术后320例获得随访,随访时间2.0～58.8个月,中位时间14.4个月,生化复发率33.4％(107/320),术后1年的控尿率为86.6％ (277/320).结论 机器人辅助腹腔镜下根治性前列腺切除术治疗高危前列腺癌是一项可行、安全及有效的治疗方式.术前PSA和临床分期是术后病理切缘阳性的危险因素.

abstractsObjective To study the short-term effectiveness of robotic-assisted laparoscopic radical prostatectomy in high-risk prostate cancer.Methods From March 2012 to March 2017,400 patients with high-risk prostate who underwent robotic-assisted laparoscopic radical prostatectomy were reviewed.The median age was 68 years old(ranged from 49 to 83 years),and the median PSA was 23.1 ng/ ml(ranged from 5.2 to 999.0 ng/ml).Preoperative parameters,surgical interventional data,postoperative pathology and follow-up data were collected.Logistic regression was used to analyze the risk factors of positive surgical margin in postoperative pathology.Results All the operations were successfully completed.Median operation time was 115 min(ranged 50-555 min),and median estimated blood loss was 110 ml(ranged 30-500 ml).Six patients had perioperative complications,among which two were rectal injury,two were cardio-cerebrovascular disease and two were hemorrhage.There was no perioperative death.Positive surgical margin was detected in 151 patients,accounting for 37.8％.A total of 345 cases (86.3％) underwent lymphadenectomy,of which 253 cases (63.3％) were performed standardized resection and 92 cases (23％) were performed extensive resection.The median number of resected lymph nodes was 9 (ranged 3-36).Eighty cases (23.2％,80/345) were positive in resected lymph nodes.Regression analysis showed that preoperative PSA ＞ 20 ng / ml or clinical stage ≥ T2c were risk factors for positive surgical margins.After a median follow-up of 14.4 months (ranged 2.0-58.8 months),the overall incidence of biochemical recurrence was 33.4％ (107/320),and the urinary continence rate one year after operation was 86.6％ (277/320).Conclusions Robotic-assisted laparoscopic radical prostatectomy in patients with high-risk prostate cancer was a feasible,safe and effective approach.Preoperative PSA and clinical stage were the risk factors for positive surgical margin.