机器人辅助腹腔镜经膀胱入路根治性前列腺切除术治疗局部晚期前列腺癌的临床疗效

陈路遥; 胡接平; 谭益帆; 刘霄强; 熊思途; 刘伟鹏; 熊晶; 王康; 刘涛; 傅斌

doi:10.13201/j.issn.1001-1420.2025.01.005

机器人辅助腹腔镜经膀胱入路根治性前列腺切除术治疗局部晚期前列腺癌的临床疗效

- 南昌大学第一附属医院泌尿外科(南昌，330006)

详细信息

通讯作者: 傅斌，E-mail：urodoc@126.com

中图分类号: R737.25

收稿日期: 2024-10-21

刊出日期: 2025-01-06

Clinical efficacy of robot-assisted laparoscopic transvesical radical prostatectomy in the treatment of locally advanced prostate cancer

- Department of Urology, First Affiliated Hospital of Nanchang University, Nanchang, 330006, China

More Information

Corresponding author: FU Bin, E-mail: urodoc@126.com

Received Date: 21 October 2024

Publish Date: 06 January 2025

摘要

摘要: 目的探讨局部晚期前列腺癌在新辅助内分泌治疗后行经膀胱入路机器人辅助腹腔镜根治性前列腺切除术(robotic assisted radical prostatectomy，RARP)的可行性和短期临床疗效。方法回顾性分析2021年1月—2023年8月南昌大学第一附属医院收治的75例局部晚期前列腺癌行经膀胱入路RARP的患者资料。患者初诊前列腺特异性抗原(prostate-specific antigen，PSA)14.1~182.8 ng/mL，平均(52.5±23.9) ng/mL，术前均接受3~6个月新辅助内分泌治疗后，PSA水平降低至0.01~4.20 ng/mL，平均(0.6±0.2) ng/mL，再行经膀胱入路RARP和扩大盆腔淋巴结清扫术。记录患者围术期情况并随访患者术后PSA及尿控情况。结果 75例患者经膀胱入路RARP和扩大盆腔淋巴结清扫术均顺利完成，无中转开放手术。手术时间为90~150 min，中位手术时间120 min；术中出血量为50~300 mL，中位出血量150 mL；术后住院时间为3~7 d，平均(4.7±0.8) d；术后引流管留置时间为3~6 d，平均(3.5±0.3) d，导尿管留置时间为10~14 d。无直肠损伤和神经损伤等术中并发症。术后病理提示14例患者切缘阳性，阳性率为18.7%；盆腔淋巴结清扫数目12~25枚，中位数16枚；25例患者有阳性淋巴结。随访时间12~32个月，术后1~3个月复查PSA为0.001~0.050 ng/mL。术后即刻、3个月、6个月和12个月尿控率分别为62.7%、85.3%、92.0%和97.3%。4例患者出现生化复发，其余患者未出现局部复发和远处转移。结论局部晚期前列腺癌行术前新辅助内分泌治疗有助于缩瘤降期，降低手术难度，经膀胱入路RARP治疗局部晚期前列腺癌是安全可行的，有较满意的肿瘤控制和早期尿控恢复效果，未来仍需多中心、大样本研究进一步验证。
- 前列腺癌 /
- 机器人手术 /
- 局部晚期 /
- 经膀胱入路 /
- 新辅助内分泌治疗
Abstract: Objective To explore the feasibility and short-term clinical efficacy of robot-assisted laparoscopic radical prostatectomy(RARP) via transvesical approach for locally advanced prostate cancer after neoadjuvant hormone therapy.Methods The data of 75 patients with locally advanced prostate cancer who underwent transvesical approach RARP in the First Affiliated Hospital of Nanchang University from January 2021 to August 2023 were retrospectively analyzed. The prostate-specific antigen(PSA) of the patients at initial diagnosis was 14.1-182.8 ng/mL, with an average of (52.5±23.9) ng/mL. After 3-6 months of neoadjuvant hormone therapy before surgery, the PSA decreased to 0.01-4.20 ng/mL, with an average of (0.6±0.2) ng/mL, and then transvesical approach RARP and extended pelvic lymph node dissection were performed. The perioperative data of the patients were recorded, and the postoperative PSA and urinary control of the patients were followed up.Results Transvesical approach RARP and extended pelvic lymph node dissection were successfully completed in 75 patients, without conversion to open surgery. The operation time was 90-150 minutes, with a median operation time of 120 minutes; the intraoperative blood loss was 50-300 mL, with a median blood loss of 150 mL; the postoperative hospital stay was 3-7 days, with an average of (4.7±0.8) days; the postoperative drainage tube retention time was 3-6 days, with an average of (3.5±0.3) days, and the catheter retention time was 10-14 days. There were no intraoperative complications such as rectal injury or nerve injury. Postoperative pathology showed that 14 patients had positive resection margins, with a positive rate of 18.7%. The number of pelvic lymph nodes dissected was 12-25, with a median of 16, and positive lymph nodes were found in 25 patients. The follow-up time was 12-32 months, and PSA was rechecked 1-3 months after surgery, with a PSA of 0.001-0.050 ng/mL. The urinary control rates were 62.7%, 85.3%, 92.0% and 97.3% immediately after surgery, 3 months, 6 months and 12 months, respectively. Biochemical recurrence occurred in 4 cases, and no local recurrence or distant metastasis was observed in the other patients.Conclusion Preoperative neoadjuvant hormone therapy for locally advanced prostate cancer can help reduce tumor size and stage, and reduce the difficulty of surgery. Transvesical RARP for locally advanced prostate cancer is safe and feasible, with satisfactory tumor control and early urinary control recovery effects. Multicenter, large-sample studies are still needed to further verify this in the future.
- prostate cancer /
- robotic surgery /
- local advanced /
- transvesical /
- neoadjuvant hormone therapy

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图 1 经膀胱入路RARP手术步骤

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