目的：探讨日间手术模式下经膀胱入路机器人辅助腹腔镜下根治性前列腺切除术（Transvesical robot-assisted laparoscopic radical prostatectomy，TvRALP）的可行性和安全性。方法：回顾性分析 2019 年 1 月 1 日 ~2020年 6 月 30 日收治的 51 例前列腺癌患者的临床资料。所有患者均行 TvRALP 术。根据患者住院流程分为日间组 24 例和住院组 27 例。收集并分析两组患者一般资料和围手术期指标，比较术后前列腺特异抗原（PSA）、尿控、性功能、并发症和住院费用的差异。结果：51 例前列腺癌患者均顺利完成手术日间组和住院组患者术前临床资料均无明显统计学差异。两组患者的手术时间 [142.5（125~181）min Vs 150（125~175min），P=0.683] 和术中出血 [50（50~75）ml Vs 50（50~50）ml，P=0.782] 无统计学差异。两组患者在术后引流管留置时间 [0（0~0）d Vs 2（0~3）d，P<0.001]、 住 院 时 间 [1（1~1）d Vs 7（6~10）d，P<0.001]、 住 院 费 用 [63 568.82（62 567.89~66 318.20）CNY Vs66 356.67（64 604.22~69 024.56）CNY,P=0.005] 方面有统计学差异。两组患者术后拔除导尿管后即刻尿控率分别为33.3%、29.6%（P=0.776）；手术 3 个月后尿控率分别为 79.2%、77.8%（P=0.904）；术后 3 月 IIEF-5 评分为 13.50（9.5~16）分11（8.5~17.5）分（P=0.285）。两组患者术后各有 1 例并发症（P=1.000）。所有患者术后切缘均为阴性。术后 1 月和 3 月PSA（P=0.417、0.899）、术后病理分期（P=0.863）和术后 Gleason 评分（P=0.458）均无统计学差异。结论：日间手术模式下行经膀胱入路的机器人辅助前列腺切除术治疗前列腺癌安全、有效，能显著缩短患者引流管留置时间、住院时间和住院费用。

Objective: To assess the safety and feasibility of transvesical robot-assisted radical prostatectomy (TvRALP) by day surgery. Methods: A retrospective review of 51 patients with prostate cancer who underwent TvRALP at our institution from January 2019 to June 2020 was performed. The patients were divided into the day surgery group (n=24) and the traditional group (n=27) based on the length of hospital stay. Baseline characteristics, perioperative outcomes, complications, oncological results, PSA, hospital costs, and functional outcomes were compared between the day surgery group and traditional group. Results: There was not significantly difference on patient’s characteristics between the two groups. No significant differences were observed between the day surgery group and traditional group in terms of operative time (median 142.5 [IQR 125-181] Vs 150 [IQR 125-175], P=0.683) and estimated blood loss (median 50 [IQR 50-75] Vs 50 [IQR 50-50], P=0.782). Statistically significant difference was found between the two groups on the length of hospital stay (median 1 [IQR 1-1] Vs 7 [IQR 6-10], P<0.001), indwelling time of drainage tube (median 0 [IQR 0-0] Vs 2 [IQR 0-3], P<0.001) and hospitalization cost (median 63568.82 [IQR 62567.89-66318.20] Vs 66356.67 [IQR 64604.22-69024.56], P=0.005). The continence rate were 33.3% Vs 29.6% (P=0.776) when removing the catheter and 79.2% Vs 77.8% (P=0.904) 3 months after operation. Sexual function scores (measured with the IIEF-5) showed no statistical difference between the day surgery group and traditional group (median 13.5 [IQR 9.5-16] Vs 11[IQR 8.5-17.5], P=0.285). 1 postoperative complication in each group (P=1.000). All the 51 patients had a negative surgical margin. No statistically significant differences on postoperative PSA (1 month P=0.417, 3 months P=0.899), postoperative pathological staging (P=0.863) and postoperative Gleason score (P=0.458). Conclusion: TvRALP is safe and effective in the treatment of prostate cancer under day surgery. Compared with the traditional group, the day surgery can significantly shorten the indwelling time of drainage tube, length of hospital stay and reduce hospitalization costs.

收稿日期：2020-10-15  录用日期：2021-02-03

Received Date: 2020-10-15  Accepted Date: 2021-02-03

基金项目：浙江省医药卫生科技项目（2020375998）；浙江省自然科学基金（LY16H280001）

Foundation Item: Medical Health Science and Technology Project of Zhejiang Provincial Health Commission(2020375998);

Natural Science Foundation of Zhejiang Province (LY16H280001)

通讯作者：经霄，Email：0095460@zju.edu.cn

Corresponding Author: JING Xiao, Email: 0095460@zju.edu.cn

引用格式：徐臻，李忠义，郑嘉文，等 . 日间手术模式行经膀胱入路机器人辅助腹腔镜下根治性前列腺切除术的临床研究 [J]. 机器人外科学杂志（中英文），2021，2（4）：287-294.

Citation: XU Z,  LI Z Y,  ZHENG J W,  et al. Clinical study of transvesical robot-assisted laparoscopic radical prostatectomy in the treatment of prostate cancer under day surgery mode [J]. Chinese Journal of Robotic Surgery, 2021, 2(4):287-294.

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