Davinci机器人系统在前列腺癌手术中的临床应用研究

发布时间：2018-05-08 12:53

  本文选题：Davinci机器人 + 前列腺癌　； 参考：《中国人民解放军医学院》2017年博士论文

【摘要】：根治性前列腺切除术是治疗前列腺癌的主要手术方式,机器人手术系统发展迅速,本研究探讨Davinci机器人手术系统在国内前列腺癌治疗中的临床应用。第一部分:Davinci机器人辅助前列腺根治性切除术治疗前列腺癌的长期肿瘤控制效果研究:系统综述和Meta分析目的:通过Meta分析评估Dav i nc i机器人辅助前列腺根治性切除术治疗前列腺癌的长期肿瘤控制效果。方法:检索、录入PubMed、Medli ne、Embase、Cochrane Centra l Register of Control led Trial s (2010-2016)数据库,纳入机器人辅助腹腔镜下前列腺根治性切除术治疗前列腺癌的长期肿瘤控制效果的临床试验。结果:20个研究5年总生化无复发生存率80%,4个研究5年长期肿瘤特异性生存率结果为97%,等。结论:机器人辅助前列腺根治性切除术对于前列腺癌患者具有较高长期生化无复发生存率和肿瘤特异性生存率。第二部分:Davinci机器人辅助腹腔镜下根治性前列腺切除术治疗前列腺癌的临床疗效研究目的:探讨Davinci机器人辅助腹腔镜根治性前列腺切除术治疗前列腺癌患者效果。方法:2008-2015年在解放军总医院泌尿外科行前列腺根治性切除术的948例患者,机器人组673例,腹腔镜组275例,比较临床疗效。结果:机器人辅助腹腔镜根治性前列腺切除术治疗不同危险度前列腺癌患者,围手术期指标无明显差异,高危险度预示较高的包膜外侵犯率等,相比腹腔镜具有更短的引流管留置时间。结论:Dav i nc i机器人辅助腹腔镜根治性前列腺切除术治疗前列腺癌,适合临床应用。第三部分:Davinci机器人辅助根治性前列腺切除术的学习曲线目的:研究单术者行机器人辅助腹腔镜下根治性前列腺切除术的学习曲线。方法:通过对2008-2015年解放军总医院泌尿外科行前列腺根治性切除术的4组597例患者临床资料分析,研究单术者学习曲线。结果:开展150例手术后,围手术期指标、肿瘤控制效果等达到理想效果。结论:机器人辅助腹腔镜下根治性前列腺切除术术者在实施150例手术后进入稳定的平台期。第四部分:前列腺癌RALP术后Gleason评分变化及影响因素的研究目的:探讨机器人平台前列腺癌患者术后Gleason评分变化及影响因素。方法:2008-2015年在解放军总医院泌尿外科行前列腺根治性切除术的351例前列腺癌患者分组,探讨评分升降影响因素。结果:前列腺体积、主要和次要Gleason评分≥4是术后Gleason评分升降级影响因素。结论:机器人辅助腹腔镜下根治性前列腺切除术患者术后Gleason评分变化影响因素包含前列腺体积、主要和次要Gl eason评分≥4。
[Abstract]:Radical prostatectomy is the main surgical method for the treatment of prostate cancer, and the robotic surgery system is developing rapidly. This study aims to explore the clinical application of Davinci robotic surgery system in the treatment of prostate cancer in China. Part one: study on the effect of long-term tumor control in the treatment of prostate cancer with the help of the robot in the treatment of prostate cancer: systematic review and Meta analysis objective: to evaluate the Dav I NC robot-assisted radical prostatectomy by Meta analysis Long-term tumor control after resection of prostate cancer. Methods: the database of PubMedli Medli Centra l Register of Control led Trial s was searched and entered into the clinical trial of long-term tumor control effect of Robo-assisted laparoscopic radical prostatectomy for prostate cancer. Results: the 5-year overall biochemical recurrence free survival rate was 80% in 20 studies and 97% in 4 studies. Conclusion: Robot-assisted radical prostatectomy has high long term biochemical recurrence free survival rate and tumor specific survival rate for prostate cancer patients. The second part: clinical efficacy of Davinci robot-assisted laparoscopic radical prostatectomy in the treatment of prostate cancer objective: to investigate the efficacy of Davinci robot-assisted laparoscopic radical prostatectomy in the treatment of prostate cancer. Methods 948 patients underwent radical prostatectomy in urology department of General Hospital of Chinese PLA from 2008 to 2015, including 673 cases in robot group and 275 cases in laparoscopic group. Results: Robot-assisted laparoscopic radical prostatectomy for prostate cancer with different risk had no significant difference in perioperative period, and high risk could predict a higher rate of extracapsular invasion. Compared with laparoscopy, drainage tube retention time is shorter. ConclusionTwo Dav I NC I robot assisted laparoscopic radical prostatectomy for prostate cancer is suitable for clinical use. Part three: the Learning Curve of Robo-assisted radical Prostatectomy in Davinci objective: to study the learning curve of robotic assisted laparoscopic prostatectomy for single operation. Methods: the clinical data of 597 patients undergoing radical prostatectomy in urology department of PLA General Hospital from 2008 to 2015 were analyzed. Results: after 150 cases of operation, the index of perioperative period and the effect of tumor control were satisfactory. Conclusion: Robo-assisted laparoscopic radical prostatectomy is stable in 150 patients. Part IV: study on the changes of Gleason score and its influencing factors after RALP in prostate cancer objective: to investigate the changes and influencing factors of Gleason score in patients with prostate cancer after robot platform operation. Methods 351 patients with prostate cancer who underwent radical prostatectomy in urology department of General Hospital of Chinese PLA from 2008 to 2015 were divided into two groups. Results: prostate volume, primary and secondary Gleason scores 鈮，

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