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| 机器人辅助下前列腺癌根治术中“双三明治”式尿道分离技巧 |
| 杨波1△,倪伟平2△,过菲1,鲁欣1,王辉清1,高旭1,许传亮1,孙颖浩1* |
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(1. 第二军医大学长海医院泌尿外科, 上海 200433;
2. 解放军98医院泌尿外科, 湖州 313000
△共同第一作者
*通信作者) |
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| 摘要: |
| 目的 探讨机器人辅助下前列腺癌根治术中尿道分离的技巧。方法 通过对尿道周围解剖结构的研究和手术视频的回顾，总结“双三明治”式尿道分离方法，并归纳出6个手术操作要点：找准“黄金眼”、扎紧静脉丛、斜坡入路、持续张力、两翼松解、下底掏空。2013年6月至9月，采用“双三明治” 式尿道分离方法，单术者完成20例机器人辅助下前列腺癌根治术，其中T2N0M0 14例，T3N0M0 3例，T4N0M0 3例（新辅助治疗3个月）。结果 手术均顺利完成，无中转开放，平均手术时间（138±47.8）min，出血（150±67.4）mL，膀胱尿道吻合时间（13±6.5）min。利用“双三明治” 式尿道分离法，成功解剖性游离尿道17例。失败3例中，2例系尖部粘连，解剖层次不清；1例因出血较多，影响视野。完整保留尿道的患者术后（拔导尿管1 d）控尿率64.7%（11/17），尖部切缘阳性11.8%（2/17），进一步随访仍在进行中。结论 在达芬奇机器人系统的辅助下，采用“双三明治”式尿道分离方法，可解剖性游离尖部尿道，降低膀胱尿道吻合难度。 |
| 关键词: 机器人 前列腺肿瘤 前列腺根治术 尿道 控尿功能 |
| DOI：10.3724/SP.J.1008.2014.01016 |
| 投稿时间：2013-12-09修订日期：2014-05-13 |
| 基金项目:第二军医大学长海医院“1255”学科建设基金. |
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| “Double sandwich” technique for urethral separation during robotic-assisted radical prostatectomy |
| YANG Bo1△,NI Wei-ping2△,GUO Fei1,LU Xin1,WANG Hui-qing1,GAO Xu1,XU Chuan-liang1,SUN Ying-hao1* |
(1. Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China;
2. Department of Urology, No. 98 Hospital of PLA, Huzhou 313000, Zhejiang, China
△Co-first authors.
* Corresponding author.) |
| Abstract: |
| Objective To explore a technique for urethral separation in robotic-assisted radical prostatectomy. Methods After studying the anatomy of the urethra and the surround structures and watching the surgical video of robotic-assisted radical prostatectomy, we summarized the following six points of the "double sandwich" technique for urethral separation: to identify the golden eye, ligate the deep dorsal penile vein, approach via the slope road, sustained tension, relieve the lateral attachment of urethra, and pass through the plane between the urethral and Denonvilliers' fascia. From June 2013 to September 2013, a single surgeon performed 20 cases of robotic-assisted radical prostatectomy, including 14 cases of T2N0M0, and 3 cases of T3N0M0, 3 cases of T4N0M0 (with 3 months of neoadjuvant therapy). Results The procedures were successfully completed in all cases without conversion to open surgery, with the average operative time being (138 ±47.8) min, blood loss being (150±67.4) mL, and bladder-urethra anastomosis time being (13±6.5) min. "Double sandwich" technique was successfully used for urethral separation in 17 cases. Of the 3 cases with failed separation, 2 had basal tip adhesions and 1 had too much bleeding and affected the vision. The post-operation rate of urinary control was 64.7%(11/17)and the positive margin was noticed in 2(11.8%) of the 17 patients. Currently the patients were still followed up. Conclusion "Double sandwich" technique in robotic-assisted radical prostatectomy can separate the urethral anatomy, which may reduce the difficulty of bladder-urethra anastomosis. |
| Key words: robotics prostatic neoplasms radical prostatectomy urethra urinary continence |
