摘要
目的:探讨达芬奇机器人辅助腹腔镜根治性前列腺切除术(RARP)不同手术入路的疗效与术后肠梗阻(POI)发生的相关因素。方法:回顾性选取2022年6月—2023年12月武汉市第一医院收治的行RARP患者114例,根据手术入路的不同,分为观察组(n=57,采用膀胱后入路)和对照组(n=57,采用膀胱前入路),患者均完成至少1年随访。比较两组手术指标及尿控恢复情况。采用Logistic回归分析RARP后发生肠梗阻的影响因素,采用ROC曲线分析预测变量的准确性。结果:两组手术时间、术中出血量、术后住院时间、尿管留置时间、卧床时间、切缘阳性率对比,差异无统计学意义(P>0.05)。观察组拔出尿管即刻、术后3个月时尿控恢复率高于对照组(P<0.05),术后6个月、12个月时,两组尿控恢复率差异无统计学意义(P>0.05)。114例患者中有11例(9.65%)发生POI。多因素Logistic回归分析结果显示,术中出血量、术后TNF-α、术后住院时长、合并心脏疾病、术前化疗是影响POI的独立危险因素,术前WBC、术后血清ALB是其保护因素(P<0.05)。ROC曲线分析结果显示,术中出血量、术后TNF-α、术后住院时长、术后血清ALB、术前WBC对预测POI均有一定价值(P<0.05)。结论:达芬奇机器人辅助腹腔镜膀胱前入路和后入路根治性前列腺切除术后患者均恢复较快,但膀胱后入路患者早期尿控恢复效果更佳。术中出血量、术后TNF-α、术后住院时长、合并心脏疾病、术前化疗是影响POI的独立危险因素,术前WBC、术后血清ALB是其保护因素,临床需高度关注,积极采取预防措施,以降低POI风险,促进术后恢复。
Objective:To investigate the efficacy of different surgical approaches in Da Vinci robot-assisted laparoscopic radical prostatectomy(RARP)and the risk factors associated with postoperative ileus(POI).Methods:A retrospective analysis was conducted on 114 patients who underwent RARP at Wuhan No.1 Hospital from June 2022 to December 2023.Based on the surgical approach,patients were divided into the observation group(n=57,posterior bladder approach)and the control group(n=57,anterior bladder approach).All patients were followed up for at least one year.Surgical outcomes and urinary continence recovery were compared between the two groups.Logistic regression was used to analyze the influencing factors of POI after RARP,and ROC curves were employed to evaluate the predictive accuracy of relevant variables.Results:There were no significant differences between the two groups in terms of operative time,intraoperative blood loss,postoperative hospital stay,catheter induration time,bed rest duration,or positive surgical margin rate(P>0.05).The observation group showed higher urinary continence recovery rates immediately after catheter removal and at 3 months postoperatively compared to the control group(P<0.05),but no significant differences were observed at 6 and 12 months(P>0.05).Among the 114 patients,11(9.65%)developed POI.Multivariate Logistic regression analysis revealed that intraoperative blood loss,postoperative TNF-αlevels,postoperative hospital stay,comorbid heart disease,and preoperative chemotherapy were independent risk factors for POI,while preoperative WBC count and postoperative serum albumin(ALB)levels were protective factors(P<0.05).ROC curve analysis demonstrated that intraoperative blood loss,postoperative TNF-αlevels,postoperative hospital stay,postoperative serum ALB,and preoperative WBC count had predictive value for POI(P<0.05).Conclusion:Both anterior and posterior bladder approaches in Da Vinci robot-assisted laparoscopic radical prostatectomy allow rapid postoperative recovery,but the posterior approach offers better early urinary continence outcomes.Intraoperative blood loss,postoperative TNF-αlevels,prolonged hospital stay,comorbid heart disease,and preoperative chemotherapy are independent risk factors for POI,while preoperative WBC count and postoperative serum ALB levels are protective factors.Clinicians should prioritize these factors and implement proactive preventive measures to reduce POI risk and enhance postoperative recovery.
作者
汪婷
胡宇
郑福鑫
周高峰
WANG Ting;HU Yu;ZHENG Fuxin;ZHOU Gaofeng(Department of Operating Room,Wuhan No.1 Hospital/Wuhan Hospital of Traditional Chinese and Western Medicine,Wuhan 430030,China;Department of Urology,Wuhan Asia Heart General Hospital,Wuhan 430056,China;Department of Urology,Wuhan No.1 Hospital/Wuhan Hospital of Traditional Chinese and Western Medicine,Wuhan 430030,China)
出处
《机器人外科学杂志(中英文)》
2025年第7期1115-1121,共7页
Chinese Journal of Robotic Surgery
基金
武汉市知识创新专项项目(2022020801020533)。
关键词
机器人辅助手术
前列腺癌
手术入路
根治性前列腺切除术
肠梗阻
Robot-assisted Surgery
Prostate Cancer
Surgical Bladder Approach
Radical Prostatectomy
Intestinal Obstruction
