Robot-assisted laparoscopic radical prostatectomy after colorectal cancer surgery: preliminary experience of 7 cases and literature review
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摘要: 目的 探讨结直肠癌术后前列腺癌患者行机器人辅助腹腔镜前列腺癌根治术的安全性和有效性。方法 回顾性分析2020年10月—2023年10月于北京大学第三医院和上海市第一人民医院由单一术者主刀的结直肠癌术后接受机器人辅助腹腔镜前列腺癌根治术的患者资料，分析其围术期结果、功能学结果和肿瘤学结果。结果 共有7例患者纳入分析，所有患者均在完全机器人辅助下完成手术，无一例患者中转开放。患者的平均手术时间为203 min，平均术中出血量为96 mL。所有患者均未发生直肠损伤等术中并发症。术后6个月所有患者(100%)均恢复自主控尿，但仅有1例(14.3%)患者保留勃起功能。结论 初步结果显示，结直肠癌术后行机器人辅助腹腔镜前列腺癌根治术是安全可行的。患者术后控尿功能恢复良好，然而性功能的保留不尽如人意。Abstract: Objective To investigate the safety and effectiveness of robot-assisted laparoscopic radical prostatectomy after previous colorectal cancer surgery.Methods Data of patients who underwent robot-assisted laparoscopic radical prostatectomy after colorectal surgery by a single surgeon at Peking University Third Hospital and Shanghai General Hospital from October 2020 to October 2023 were retrospectively collected, and their perioperative, functional and oncological outcomes were analyzed.Results A total of 7 patients were included in the analysis, and all of them recieved full robot-assisted radical prostatectomy without conversion to open surgery. The mean operative time was 203 minutes and the mean intraoperative blood loss was 96 mL. No intraoperative complications such as rectal injury occurred. All patients (100%) retained urinary continence at 6 months after surgery, but only 1 patient (14.3%) were able to achieve erection with or without medical aid.Conclusion Preliminary results indicate that robot-assisted laparoscopic radical prostatectomy after colorectal cancer surgery is safe and feasible. Most patients retained urinary continence after surgery, but the retention of sexual function was unsatisfactory.
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Key words:
- robotics /
- prostate cancer /
- radical prostatectomy /
- colorectal cancer /
- complication
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表 1 患者临床病理资料
项目 病例1 病例2 病例3 病例4 病例5 病例6 病例7 年龄/岁 64 71 79 53 77 64 77 BMI/(kg/m2) 28.3 24.5 21.3 30.3 23.1 23.8 25.7 结直肠肿瘤位置 直肠 直肠 结肠 直肠 降结肠 直肠 直肠 手术入路 腹腔镜 腹腔镜 腹腔镜 腹腔镜 腹腔镜 腹腔镜 腹腔镜 结直肠癌术式 Dixon Dixon 不详 Dixon 左半结肠切除 Dixon Dixon 手术间隔时间/月 8 40 24 24 120 51 36 结直肠术后放疗 否 否 否 否 否 否 否 结直肠术后化疗 否 否 是 否 是 是 是 手术时间/min 285 175 190 180 288 184 125 术中出血量/mL 200 50 100 40 200 50 30 术中并发症 否 否 否 否 否 否 否 直肠损伤 否 否 否 否 否 否 否 术后住院日/d 4 4 3 5 3 4 4 导尿管留置时间/d 10 10 13 13 13 10 11 术前PSA/(ng/mL) 98.3 32.8 37.9 9.1 13.2 21.8 8.8 病理Gleason评分 4+3=7 未见癌 4+5=9 3+4=7 4+5=9 3+4=7 4+3=7 TNM分期 T3bN0M0 — T3bN0M0 T2bN0M0 T3aN0M0 T3aN0M0 T3aN0M0 切缘情况 阳性 — 阳性 阴性 阳性 阴性 阳性 术后辅助治疗 ADT+放疗 无 放疗 无 放疗 无 无 
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