2019 年 12 月四川省人民医院收治 1例 80 岁大体积前列腺癌患者。MRI 提示前列腺体积 200cm 3，前列腺周围叶病变，考虑肿瘤占位可能性大，预计分期  T3，且前列腺增生伴多发结节形成。影像学检查提示未见转移征象。囚患者对术后尿控功能要求较高，又属高龄患者，签署知情同意书后行经腹膜外机器人辅助腹腔镜前列腺癌  根治术，以探讨经腹膜外机器人辅助腹腔镜治疗大体积(>100ml)前列腺癌的疗效及安全性。手术进展顺利，用时220min，术中出血 300ml，术中未发生任何并发症，术后 12d 拔除尿管后患者即刻控尿。结果表明，经腹膜外机器人辅助腹腔镜治疗大体积前列腺癌是安全、有效的，并在保护患者尿控及缩短住院时间方面具有优势。但远期疗效  需进一步随访及扩大样本噩再进行比较。

The patient was 80 years old with frequent and difficult urination for 2 weeks before admission to Sichuan Provincial People’s Hospital in December 2019. MRI results showed that the prostate size was about 200cm3, which indicated a tumor occupation staging T3 BPH (Benign prostatic hyperplasia) combined with multiple nodules being formed. No evidence of metastasis was found by imaging examination. Considering the high requirement on urine continence and advanced age of the patient, extraperitoneal robot-assisted laparoscopic radical prostatectomy was performed with patient’s consent to explore the efficacy and safety of transperitoneal robot-assisted laparoscopy in the treatment of large-volume >100ml) prostate cancer.The surgery was successfully performed within 220min with 300ml of intraoperative bleeding. No complications occurred during the operation.The postoperative exhaust time was 36h and the patient recovered urine continence immediately after removing urinary catheter 12 days after the operation.The results show that robot-assisted laparoscopic radical prostatectomy is safe, effective and feasible to treat prostate cancer patients with large glands. It can shorten the hospital stay and protect urine continence. However, the long-term effect shall be analyzed based on further follow-up and larger sample size.

收 稿 日 期 ：2020-02-20 录 用 日 期 ：2020-05-15 

Received Date: 2020-02-20  Accepted  Date:  2020-05-15 

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: WANG Dong, Email: wangdong_robot@163.com

引用格式：吕倩，任尚青，陈正军，等 . 经腹膜外机器人辅助腹腔镜治疗大体积前列腺癌—例报道 [J]. 机器人外科学杂志， 2021，2(1) 72-76.

Citation:  LV 0, REN S 0, CHEN Z J, et al. Robot-assisted laparoscopic radical prostatectomy for prostate cancer with large glands: a case report[J]. Chinese Journal of Robotic Surgery, 2021, 2 (1): 72-76.

[1]Kimura T, Egawa S.Epidemiology of prostate cancer in Asian countries[J]. Int J Urol, 2018, 25 (6): 524-531.

[2]Basiri A, de la Rosette J J, Tabatabaei S et al. Comparison of retropubic, laparoscopic and robotic radical prostatectomy: who is the winner?[J].World J Urol, 2018, 36 (4): 609-621.

[3]Ilic D, Evans S M, Allan C A, et al.Laparoscopic and robotic-assisted versus open radical prostatectomy for the treatment of localised prostate cancer[J].Cochrane Database Syst Rev, 2017. DOI: 10.1002／14651858. CD009625.pub2.

[4]Pompe R S, Beyer B Haese A, et al.Postoperative complications of contemporary open and robot-assisted laparoscopic radical prostatectomy using standardised reporting systems[J]. BJU Int, 2018, 122 (5): 801-807.

[5]Takayanagi A Takahashi A, Yorozuya W, et al. Predictive Factor of Urinary Continence after Robot- Assisted Laparoscopic Radical Prostatectomy[J]. Hinyokika Kiyo, 2019, 65 (11): 451-454.

[6]Xia L Sperling C D, Taylor B L et al.Associations Between Hospital Volume and Outcomes of Robot- Assisted Radical Prostatectomy[J].J Urol, 2019. DOI: 10.1097／JU.000000 0000000698.

[7]Lee J, Kim H Y, Goh H J, et al. Retzius Sparing Robot- Assisted Radical Prostatectomy Conveys Early Regain of Continence over Conventional Robot-Assisted Radical Prostatectomy: A Propensity Score Matched Analysis of 1, 863 Patients[J]. J Urol, 2020, 203 (1): 137-144.

[8]Cockrell R Bonzo J, Lee D.Robot-Assisted Simple Prostatectomy[J]. J Endourol, 2018, 32 (S1): S33-S38.

[9]Park J S, Kim J, Jang W S, et al.Management of postoperative ileus after robot-assisted laparoscopic prostatectomy[J]. Medicine Baltimore), 2018, 97 44): e13036.

[10]SHAO I H, CHANG Y H HOU C M, et al. Predictors of short-term and long-term incontinence after robot- assisted radical prostatectomy[J]. J Int Med Res, 2018, 46 (1): 421-429.

[11]Hsu E I Hong E K, Lepor H.Influence of body weight and prostate volume on intraoperative, perioperative, and postoperative outcomes after radical retropubic prostatectomy[J]. Urology, 2003, 61 (3): 601-606.

[12]Chen R Sjoberg D D Huang Y et al. Prostate Specific Antigen and Prostate Cancer in Chinese Men Undergoing Initial Prostate Biopsies Compared with Western Cohorts[J]. The Journal of Urology, 2017, 1): 90-96.

[13]Olsson C A Lavery H J Sebrow D et al.Does size matter? The significance of prostate size on pathologic and functional outcomes in patients undergoing robotic prostatectomy[J]. Arab Journal of Urology, 2011, 9 3): 159-164.

[14]Ficarra V Novara G, Artibani W, et al. Retropubic, Laparoscopic, and Robot - Assisted Radical Prostatectomy: A Systematic Review and Cumulative Analysis of Comparative Studies[J].European Urology, 2009, 55 (5): 1037-1063.

[15]Dobbs R W Halgrimson W R, Madueke I et al.Single- port robot-assisted laparoscopic radical prostatectomy: initial experience and technique with the da Vinci R)) SP platform[J].BJU Int, 2019, 124 (6): 1022-1027.

[16]Mattevi D, Luciani L G, Vattovani V, et al.First case of robotic laparoendoscopic single-site radical prostatectomy with single-site VesPa platform[J].J Robot Surg, 2018, 12 (2): 381-385.

[17]SHAO I H CHANG Y H HOU C M et al.Predictors of short-term and long-term incontinence after robot- assisted radical prostatectomy[J].J Int Med Res, 2018, 46 (1): 421-429.