本文選題：Davinci機器人 + 前列腺癌��； 參考：《中國人民解放軍醫(yī)學院》2017年博士論文

【摘要】：根治性前列腺切除術(shù)是治療前列腺癌的主要手術(shù)方式,機器人手術(shù)系統(tǒng)發(fā)展迅速,本研究探討Davinci機器人手術(shù)系統(tǒng)在國內(nèi)前列腺癌治療中的臨床應(yīng)用。第一部分:Davinci機器人輔助前列腺根治性切除術(shù)治療前列腺癌的長期腫瘤控制效果研究:系統(tǒng)綜述和Meta分析目的:通過Meta分析評估Dav i nc i機器人輔助前列腺根治性切除術(shù)治療前列腺癌的長期腫瘤控制效果。方法:檢索、錄入PubMed、Medli ne、Embase、Cochrane Centra l Register of Control led Trial s (2010-2016)數(shù)據(jù)庫,納入機器人輔助腹腔鏡下前列腺根治性切除術(shù)治療前列腺癌的長期腫瘤控制效果的臨床試驗。結(jié)果:20個研究5年總生化無復發(fā)生存率80%,4個研究5年長期腫瘤特異性生存率結(jié)果為97%,等。結(jié)論:機器人輔助前列腺根治性切除術(shù)對于前列腺癌患者具有較高長期生化無復發(fā)生存率和腫瘤特異性生存率。第二部分:Davinci機器人輔助腹腔鏡下根治性前列腺切除術(shù)治療前列腺癌的臨床療效研究目的:探討Davinci機器人輔助腹腔鏡根治性前列腺切除術(shù)治療前列腺癌患者效果。方法:2008-2015年在解放軍總醫(yī)院泌尿外科行前列腺根治性切除術(shù)的948例患者,機器人組673例,腹腔鏡組275例,比較臨床療效。結(jié)果:機器人輔助腹腔鏡根治性前列腺切除術(shù)治療不同危險度前列腺癌患者,圍手術(shù)期指標無明顯差異,高危險度預(yù)示較高的包膜外侵犯率等,相比腹腔鏡具有更短的引流管留置時間。結(jié)論:Dav i nc i機器人輔助腹腔鏡根治性前列腺切除術(shù)治療前列腺癌,適合臨床應(yīng)用。第三部分:Davinci機器人輔助根治性前列腺切除術(shù)的學習曲線目的:研究單術(shù)者行機器人輔助腹腔鏡下根治性前列腺切除術(shù)的學習曲線。方法:通過對2008-2015年解放軍總醫(yī)院泌尿外科行前列腺根治性切除術(shù)的4組597例患者臨床資料分析,研究單術(shù)者學習曲線。結(jié)果:開展150例手術(shù)后,圍手術(shù)期指標、腫瘤控制效果等達到理想效果。結(jié)論:機器人輔助腹腔鏡下根治性前列腺切除術(shù)術(shù)者在實施150例手術(shù)后進入穩(wěn)定的平臺期。第四部分:前列腺癌RALP術(shù)后Gleason評分變化及影響因素的研究目的:探討機器人平臺前列腺癌患者術(shù)后Gleason評分變化及影響因素。方法:2008-2015年在解放軍總醫(yī)院泌尿外科行前列腺根治性切除術(shù)的351例前列腺癌患者分組,探討評分升降影響因素。結(jié)果:前列腺體積、主要和次要Gleason評分≥4是術(shù)后Gleason評分升降級影響因素。結(jié)論:機器人輔助腹腔鏡下根治性前列腺切除術(shù)患者術(shù)后Gleason評分變化影響因素包含前列腺體積、主要和次要Gl eason評分≥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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