机器人腹腔镜前列腺癌根治术与传统腹腔镜前列腺癌根治术的临床对比研究

发布时间：2018-04-03 18:50

  本文选题：前列腺癌　切入点：机器人腹腔镜　出处：《郑州大学》2017年硕士论文

【摘要】：背景前列腺癌在欧美发达国家是男性最常见的恶性肿瘤之一,也是男性肿瘤死亡的主要原因之一,在欧美发达国家其发病率和死亡率分别居男性恶性肿瘤第一位、第二位。我国前列腺癌的发病率和死亡率均低于欧美发达国家,但随着生活质量的逐渐改善、人口老龄化以及PSA早期筛查的日渐普及,我国的前列腺癌发病率和死亡率也一直呈逐年上升的趋势。迄今为止,前列腺癌根治术是治疗局限性前列腺癌及部分高危前列腺癌最有效的方法。随着外科手术里面微创技术的不断发展,前列腺癌根治术已由传统的开放手术发展至今日的腹腔镜和机器人腹腔镜手术。2000年德国学者采用达芬奇机器人实施了首例机器人腹腔镜前列腺癌根治术,而国内解放军总医院也于2007年10月使用达芬奇机器人完成首例机器人腹腔镜前列腺癌根治术。目前国内多家医院已陆续引进达芬奇机器人手术系统,其在前列腺癌根治术中的优势已被国内泌尿外科医师所认可。目的本研究旨在通过机器人腹腔镜前列腺癌根治术与传统腹腔镜前列腺癌根治术的疗效对比,评价其临床应用的安全性和可行性。方法回顾性分析我院泌尿外科自2014年9月至2016年9月期间行前列腺癌根治术患者165例,其中机器人腹腔镜前列腺癌根治术89例,传统腹腔镜前列腺癌根治术76例,通过分析患者临床资料及长期随访的结果,对机器人腹腔镜组(RARP)及腹腔镜组(LRP)的手术时间、术中出血量、输血发生率、术后下床活动时间、术后切缘阳性率、术后漏尿率、术后拔除引流管时间、术后住院时间、术后3月、6月、12月尿控情况、生化复发率进行对比。两组数据均采用SPSS 19.0统计软件包分析处理,根据不同情况选用t检验、χ2检验进行分析,以P0.05差异有统计学意义。结果自2014年9月至2016年9月,我们共完成机器人腹腔镜前列腺癌根治术89例,所有手术均顺利完成,无中转开放,手术时间54~147min,平均(89±40.7)min,术中出血20~600ml,平均(178±173.5)ml,术后下床活动时间1~3天,平均(1.5±0.6)天,术后拔除引流管时间2~43天,平均(7.1±4.9)天,术后住院时间5~29d,平均(8.9±4.0)d,术后切缘阳性率18.0%(16/89),术后出现并发症9例(10.1%),漏尿3例,感染1例,肠梗阻2例,尿道狭窄2例,切口疝1例,8例经保守治疗好转,1例经疝修补好转。术后随访1~23月,平均(9.8±7.3)月,3个月完全尿控率86.6%(58/67),6个月完全尿控率92.7%(51/55),12个月完全尿控率96.9%(31/32),7例术后出现生化复发,1例术后出现多发转移,1例术后死亡。自2014年9月至2016年9月,我们共完成传统腹腔镜前列腺癌根治术76例,所有手术均顺利完成,无中转开放,手术时间68~213min,平均(118±79.4)min,术中出血10~1300ml,平均(203.4±199.3)ml,术后下床活动时间1~3天,平均(1.7±0.8)天,术后拔除引流管时间2~51天,平均(10.4±8.2)天,术后住院时间7~33d,平均(14.2±5.9)d,术后切缘阳性率14.5%(11/76),术后出现并发症13例(17.1%),漏尿7例,肠梗阻1例,尿道狭窄2例,下肢静脉血栓形成3例,13例均经保守治疗好转。术后随访1~23月,平均(9.3±7.8)月,3个月完全尿控率74.2%(46/62),6个月完全尿控率82.6%(38/46),12个月完全尿控率89.7%(26/29),8例术后出现生化复发。结论机器人腹腔镜前列腺癌根治术治疗前列腺癌安全可行,临床效果满意,与传统腹腔镜前列腺癌根治术相比,两者的肿瘤学结果与功能学结果相似,机器人腹腔镜前列腺癌根治术可以明显降低手术难度,具有手术时间短,患者术后恢复快,拔除引流管早,住院时间短等优势。
[Abstract]:Background prostate cancer is one of the most common malignancy among men in developed countries, but also one of the major causes of cancer death in men, in developed countries the incidence and mortality were ranked first, second male malignant tumor in China. Prostate cancer incidence and mortality rates are lower than in developed countries, but with the gradual improvement the quality of life, the aging population and the growing popularity of PSA early screening, the morbidity and mortality of prostate cancer has been increasing year by year. So far, radical prostatectomy is the treatment of localized prostate cancer and high-risk prostate cancer most effective. With the development of minimally invasive techniques in surgery that has been the traditional open surgery to today's laparoscopic and robotic laparoscopic surgery in Germany.2000 scholars using da Vinci radical prostatectomy The implementation of the radical operation of the first odd robot robot assisted laparoscopic prostate cancer, while the domestic general hospital of PLA in October 2007 using the Da Vinci robot to complete the first laparoscopic radical resection of prostate cancer. The robot at home and many hospitals have been the introduction of the Da Vinci surgical system, the prostatectomy advantage has been recognized by domestic Department of Urology physicians. This study was designed to compare the efficacy by robotic laparoscopic radical prostatectomy and traditional laparoscopic radical prostatectomy, safety and feasibility of the evaluation of its clinical application. Methods Retrospective analysis of our hospital from September 2014 to September 2016 for the Department of Urology during radical prostatectomy in 165 patients, including robotic laparoscopic radical prostatectomy in 89 cases, the traditional laparoscopic radical prostatectomy in 76 cases, through the analysis of the clinical data of patients with long-term and Visit the results of robot assisted laparoscopic group (RARP) and laparoscopic group (LRP). The operation time, intraoperative blood loss, the incidence rate of blood transfusion, postoperative ambulation time, postoperative positive margins, postoperative urinary leakage rate, postoperative drainage tube time, postoperative hospital stay, postoperative March in June, December, continence, compared the biochemical recurrence rate. The data of the two groups were analyzed with the statistical package SPSS 19, according to the different conditions of the t test, 2 test were analyzed by P0.05. Results there was significant difference from September 2014 to September 2016, we completed robotic laparoscopic radical prostatectomy in 89 cases and all the operations were successfully completed without conversion to open surgery, time 54~147min, average (89 + 40.7) min, bleeding 20~600ml, average (178 + 173.5) ml, postoperative ambulation time 1~3 days, average (1.5 + 0.6) days, 2~43 days time tube drainage after operation, the average (7.1. 4.9)澶，

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