探讨四孔法腹膜外机器人辅助腹腔镜根治性前列腺切除术的疗效及安全性。方法：回顾分析 2019 年 8 月 ~2019 年 12 月四川省人民医院机器人微创中心采用四孔法行腹膜外机器人辅助腹腔镜下前列腺根治术 22 例患者的临床资料，平均年龄 65.6（63~79）岁。患者术前全部活检证实为前列腺腺癌。其中 Gleason 评分≤ 6 分 3 例，7 分 15 例，8 分 3 例，9 分 1 例。MRI 未见淋巴结及远处转移。结果：22 例患者手术均顺利完成，术中未中 转开腹及增加操作通道。建立腹膜外腔及机器臂安装时间平均 45min（42~70min），手术时间平均 120min（90~180min）， 术中出血量平均 120ml（50~220ml），术后肛门排气平均时间 22h（12~48h），引流管平均留置时间 3d（2~7d）， 留置导尿管平均时间9d（6~14d），切口液化 1 例，引流管脱出 1 例。均无严重手术并发症发生。术后病理 Gleason 评分≤ 6 分 3 例、7 分 15 例、8 分 2 例、9 分 2 例。术后切缘阳性 1 例。术后 1 月复查 PSA>0.2ng/ml，提示术后肿 瘤残留，行雄激素内分泌治疗。术后拔除尿管后即刻控尿 10 例（45.4％），术后 3 个月内控尿恢复 21 例（95.4％）， 1 例患者尿失禁。结论：四孔法腹膜外机器人辅助腹腔镜下行根治性前列腺切除术可以达到很好的控瘤效果，术后 尿控及肠道功能恢复快。

To investigate the efficacy and safety of 4-hole extraperitoneal robot-assisted laparoscopic surgery in radical prostatectomy. Methods: The clinical data of 22 patients underwent extraperitoneal robot-assisted laparoscopic radical prostatectomy in Sichuan Provincial People’s Hospital from August 2019 to December 2019 were analyzed retrospectively. The average age was 65.6 (63-79). Prostate adenocarcinoma was confirmed by the biopsies made before operation. Among them, 3 cases with Gleason score ≤ 6, 15 cases=7, 3 cases=8, 1 case=9. No lymph node or distant metastasis found by MRI. All cases were treated with 4-hole extraperitoneal robot-assisted laparoscopic radical prostatectomy. Results: The 22 surgeries were all successfully completed without conversion to laparotomy or increasing of operation channels. The average installation time of extraperitoneal cavity and robot arm was 45 minutes (42-70min), the average operation time was 120 minutes (90-180min), the average intraoperative bleeding volume was 120 ml (50-220ml), the average postoperative anal exhaust time was 22 hours (12-48h), the average retention time of drainage tube was 3 days (2-7d), the average retention time of indwelling catheter was 9 days (6-14d). 1 case was found incision liquefication. Drainage tube dislocation was found in 1 case. No serious complications occurred. Postoperative pathological Gleason score ≤ 6 in 3 cases, 7 in 15 cases, 8 in 2 cases, 9 in 2 cases. Positive margin was found in 1 case. Postoperative tumor residuals were found by reexamination on PSA>0.2ng/ml 1 month after operation and androgen-deprivation therapy(ADT) was performed. 10 cases (45.4%) realized immediate urinary continence after catheter being removed, 21 cases (95.4%) recovered urinary continence within 3 months and 1 case was found with incontinence. Conclusion: 4-hole extraperitoneal robot-assisted laparoscopic radical prostatectomy has good tumor control effect and fast recovery of urine continence and intestinal function after operation.

收稿日期：2020-02-20  录用日期：2020-04-15 

Received Date: 2020-02-20  Accepted Date: 2020-04-15 

基金项目：德中机器人手术合作中心的建立 (2017HH0106) 

Foundation Item: “The establishment of Germany-China robot surgery cooperation center” (2017HH0106) 

通讯作者：王东，Email：wangdong_robot@163.com 

Corresponding Author: 王东 , Email: wangdong_robot@163. com 

引用格式：陈正军，吕倩，范世达，等 . 四孔法腹膜外机器人辅助腹腔镜前列腺根治性切除术 22 例报道 [J]. 机器人外科学杂志， 2020，1（4）：266-270. 

Citation: CHEN Z J, LV Q, FAN S D, et al. Application of 4-hole extraperitoneal robot-assisted laparoscopic surgery in radical prostatectomy: a report of 22 cases [J]. Chinese Journal of Robotic Surgery, 2020, 1(4):266-270.

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