单中心评价机器人辅助根治性前列腺切除术的腹膜外和经腹膜入路。

Marcus Horstmann, Christian Vollmer, Christoph Schwab, Michael Kurz, Christian Padevit, Kevin Horton, Hubert John
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引用次数: 17

摘要

目的:机器人辅助根治性前列腺切除术(RARP)无论采用腹膜外(EP)还是经腹膜(TP)入路都是可行的。本研究报告了一家医院使用这两种技术的经验。材料与方法:2009年7月至2011年3月,170例患者行RARP。103例采用EP, 67例采用TP。如果先前的网状疝修补术或认为有必要进行扩大淋巴结清扫(LND),则首选TP。否则,执行EP;肥胖(体重指数(BMI) > 30 kg/m(2))或既往腹部手术者优先。结果:EP和TP患者术前平均年龄(64.4 vs 65.6岁)、BMI (26.5 vs 26.3 kg/m(2))和前列腺大小(51.8 vs 55.8 cm(3))均无显著差异。由于术前选择标准,EP患者的前列腺特异性抗原水平和平均Gleason评分明显低于TP患者(p < 0.001)。虽然手术时间和吻合时间没有显著差异(21 vs 19 min, p = 0.11, 26 vs 24 min, p = 0.36),但TP的总手术时间明显更长(225 vs 191 min, p < 0.001)。两组失血量相等(EP 276 vs TP 281 ml, p = 0.88)。EP组并发症发生率较低(n = 7,6.8% vs n = 8,12%, p = 0.024)。EP患者首次排便时间和末次镇痛时间均显著缩短(p < 0.05)。结论:目前的评估结果强调了腹膜外入路治疗RARP的临床优势。然而,经腹膜入路仍然被认为是必要的延长LND或特殊的临床条件。机器人团队应该使用这两种方法进行训练。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Single-centre evaluation of the extraperitoneal and transperitoneal approach in robotic-assisted radical prostatectomy.

Objective: Robotic-assisted radical prostatectomy (RARP) is feasible using either an extraperitoneal (EP) or a transperitoneal (TP) approach. This study reports on the experience of a single hospital using both techniques.

Material and methods: From July 2009 to March 2011, 170 patients underwent RARP. EP was chosen in 103 patients and TP in 67. TP was preferred in cases previous mesh hernia repair or if extended lymph-node dissection (LND) was considered necessary. Otherwise, EP was performed; it was preferred in cases of obesity (body mass index (BMI) > 30 kg/m(2)) or previous intra-abdominal surgery.

Results: There were no significant differences in preoperative mean age (64.4 vs 65.6 years), BMI (26.5 vs 26.3 kg/m(2)) or prostate size (51.8 vs 55.8 cm(3)) between EP and TP patients. Owing to preoperative selection criteria, prostate-specific antigen levels and the average Gleason score were significantly lower in EP than in TP patients (p < 0.001). Whereas access time and time for anastomosis did not differ significantly (21 vs 19 min, p = 0.11, and 26 vs 24 min, p = 0.36, respectively), overall surgical time was significantly longer in TP (225 vs 191 min, p < 0.001). Blood loss was equal in both groups (EP 276 vs TP 281 ml, p = 0.88). Complication rates were lower in EP (n = 7, 6.8% vs n = 8, 12%, p = 0.024). Time until first defecation and last analgesic treatment were significantly shorter in EP (p < 0.05).

Conclusions: The results of the current evaluation underline the clinical advantages of an extraperitoneal approach for RARP. However, a transperitoneal approach is still considered necessary for extended LND or special clinical conditions. Robotic teams should be trained using both approaches.

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来源期刊
Scandinavian Journal of Urology and Nephrology
Scandinavian Journal of Urology and Nephrology 医学-泌尿学与肾脏学
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