本文選題：前列腺癌　切入點(diǎn)：機(jī)器人腹腔鏡　出處：《鄭州大學(xué)》2017年碩士論文

【摘要】：背景前列腺癌在歐美發(fā)達(dá)國(guó)家是男性最常見的惡性腫瘤之一,也是男性腫瘤死亡的主要原因之一,在歐美發(fā)達(dá)國(guó)家其發(fā)病率和死亡率分別居男性惡性腫瘤第一位、第二位。我國(guó)前列腺癌的發(fā)病率和死亡率均低于歐美發(fā)達(dá)國(guó)家,但隨著生活質(zhì)量的逐漸改善、人口老齡化以及PSA早期篩查的日漸普及,我國(guó)的前列腺癌發(fā)病率和死亡率也一直呈逐年上升的趨勢(shì)。迄今為止,前列腺癌根治術(shù)是治療局限性前列腺癌及部分高危前列腺癌最有效的方法。隨著外科手術(shù)里面微創(chuàng)技術(shù)的不斷發(fā)展,前列腺癌根治術(shù)已由傳統(tǒng)的開放手術(shù)發(fā)展至今日的腹腔鏡和機(jī)器人腹腔鏡手術(shù)。2000年德國(guó)學(xué)者采用達(dá)芬奇機(jī)器人實(shí)施了首例機(jī)器人腹腔鏡前列腺癌根治術(shù),而國(guó)內(nèi)解放軍總醫(yī)院也于2007年10月使用達(dá)芬奇機(jī)器人完成首例機(jī)器人腹腔鏡前列腺癌根治術(shù)。目前國(guó)內(nèi)多家醫(yī)院已陸續(xù)引進(jìn)達(dá)芬奇機(jī)器人手術(shù)系統(tǒng),其在前列腺癌根治術(shù)中的優(yōu)勢(shì)已被國(guó)內(nèi)泌尿外科醫(yī)師所認(rèn)可。目的本研究旨在通過機(jī)器人腹腔鏡前列腺癌根治術(shù)與傳統(tǒng)腹腔鏡前列腺癌根治術(shù)的療效對(duì)比,評(píng)價(jià)其臨床應(yīng)用的安全性和可行性。方法回顧性分析我院泌尿外科自2014年9月至2016年9月期間行前列腺癌根治術(shù)患者165例,其中機(jī)器人腹腔鏡前列腺癌根治術(shù)89例,傳統(tǒng)腹腔鏡前列腺癌根治術(shù)76例,通過分析患者臨床資料及長(zhǎng)期隨訪的結(jié)果,對(duì)機(jī)器人腹腔鏡組(RARP)及腹腔鏡組(LRP)的手術(shù)時(shí)間、術(shù)中出血量、輸血發(fā)生率、術(shù)后下床活動(dòng)時(shí)間、術(shù)后切緣陽(yáng)性率、術(shù)后漏尿率、術(shù)后拔除引流管時(shí)間、術(shù)后住院時(shí)間、術(shù)后3月、6月、12月尿控情況、生化復(fù)發(fā)率進(jìn)行對(duì)比。兩組數(shù)據(jù)均采用SPSS 19.0統(tǒng)計(jì)軟件包分析處理,根據(jù)不同情況選用t檢驗(yàn)、χ2檢驗(yàn)進(jìn)行分析,以P0.05差異有統(tǒng)計(jì)學(xué)意義。結(jié)果自2014年9月至2016年9月,我們共完成機(jī)器人腹腔鏡前列腺癌根治術(shù)89例,所有手術(shù)均順利完成,無中轉(zhuǎn)開放,手術(shù)時(shí)間54~147min,平均(89±40.7)min,術(shù)中出血20~600ml,平均(178±173.5)ml,術(shù)后下床活動(dòng)時(shí)間1~3天,平均(1.5±0.6)天,術(shù)后拔除引流管時(shí)間2~43天,平均(7.1±4.9)天,術(shù)后住院時(shí)間5~29d,平均(8.9±4.0)d,術(shù)后切緣陽(yáng)性率18.0%(16/89),術(shù)后出現(xiàn)并發(fā)癥9例(10.1%),漏尿3例,感染1例,腸梗阻2例,尿道狹窄2例,切口疝1例,8例經(jīng)保守治療好轉(zhuǎn),1例經(jīng)疝修補(bǔ)好轉(zhuǎn)。術(shù)后隨訪1~23月,平均(9.8±7.3)月,3個(gè)月完全尿控率86.6%(58/67),6個(gè)月完全尿控率92.7%(51/55),12個(gè)月完全尿控率96.9%(31/32),7例術(shù)后出現(xiàn)生化復(fù)發(fā),1例術(shù)后出現(xiàn)多發(fā)轉(zhuǎn)移,1例術(shù)后死亡。自2014年9月至2016年9月,我們共完成傳統(tǒng)腹腔鏡前列腺癌根治術(shù)76例,所有手術(shù)均順利完成,無中轉(zhuǎn)開放,手術(shù)時(shí)間68~213min,平均(118±79.4)min,術(shù)中出血10~1300ml,平均(203.4±199.3)ml,術(shù)后下床活動(dòng)時(shí)間1~3天,平均(1.7±0.8)天,術(shù)后拔除引流管時(shí)間2~51天,平均(10.4±8.2)天,術(shù)后住院時(shí)間7~33d,平均(14.2±5.9)d,術(shù)后切緣陽(yáng)性率14.5%(11/76),術(shù)后出現(xiàn)并發(fā)癥13例(17.1%),漏尿7例,腸梗阻1例,尿道狹窄2例,下肢靜脈血栓形成3例,13例均經(jīng)保守治療好轉(zhuǎn)。術(shù)后隨訪1~23月,平均(9.3±7.8)月,3個(gè)月完全尿控率74.2%(46/62),6個(gè)月完全尿控率82.6%(38/46),12個(gè)月完全尿控率89.7%(26/29),8例術(shù)后出現(xiàn)生化復(fù)發(fā)。結(jié)論機(jī)器人腹腔鏡前列腺癌根治術(shù)治療前列腺癌安全可行,臨床效果滿意,與傳統(tǒng)腹腔鏡前列腺癌根治術(shù)相比,兩者的腫瘤學(xué)結(jié)果與功能學(xué)結(jié)果相似,機(jī)器人腹腔鏡前列腺癌根治術(shù)可以明顯降低手術(shù)難度,具有手術(shù)時(shí)間短,患者術(shù)后恢復(fù)快,拔除引流管早,住院時(shí)間短等優(yōu)勢(shì)。
[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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