2021 年6 月徐州医科大学附属医院收治1 例75 岁去势抵抗性前列腺癌（Castration-resistant Prostate Cancer，CRPC）患者。泌尿系彩超：双肾积水，双侧输尿管全程扩张；前列腺大小约6.1cm×3.4cm×4.7cm，部分向膀胱突入，呈菜花样，范围约5.7cm×2.4cm。残余尿249ml，血肌酐1185 μmol/L，初步诊断为前列腺癌侵犯双侧输尿管开口（T4 期）。经双肾造瘘、透析治疗后血肌酐降至93μmol/L。因合并尿潴留及肾功能不全，患者及家属手术意愿强烈，经沟通手术风险并签署知情同意书后行“机器人辅助腹腔镜下前列腺癌切除+ 膀胱下半部切除+ 双侧输尿管膀胱再植术”。手术过程顺利，用时约320min，术中出血350ml，术后3 周拔除尿管。随访至今，患者血肌酐维持正常范围，有轻微尿失禁，国际前列腺症状评分（International Prostate Symptom Score，IPSS）及生活质量（Quality of Life，QoL）评分较术前明显提高。结果表明，机器人辅助腹腔镜治疗侵犯双侧输尿管开口去势抵抗性前列腺癌是安全、有效的，既可以达到减瘤作用，又解决了尿潴留及肾功能衰竭等并发症。相比术前患者排尿症状及生活质量明显提高，值得临床进一步尝试，但需进一步随访及扩大样本量进行比较分析。

In June 2021, the Affiliated Hospital of Xuzhou Medical University admitted a 75-year-old patient with castration-resistant prostate cancer (CRPC). Color Doppler ultrasound of urinary system showed hydronephrosis and dilated ureters. The size of the prostate was about 6.1cm×3.4cm×4.7cm, partly protruding into the bladder in a cauliflower-like shape,with a range of about 5.7cm×2.4cm and residual urine of 249ml. Serum creatinine was 1185 umol/L, initially diagnosed as prostate cancer invading bilateral ureteral orifices (stage T4). Blood creatinine dropped to 93 umol/L after bilateral nephrostomy

and dialysis treatment., patients and their families had strong desire to surgery due to urinary retention and renal insufficiency.After communicating the risks of surgery and signing the informed consent, robot-assisted laparoscopic resection of prostate cancer + lower bladder resection + bilateral ureter and bladder replantation were performed. The surgery was completed smoothly. It took about 320 minutes with intraoperative blood loss of 350ml. The urinary catheter was removed 3 weeks after surgery. The patient’s blood creatinine maintained a normal range with mild urinary incontinence in follow-up to now. The International Prostate Symptom Score (IPSS) and Quality of Life (QoL) score had been significantly improved comparing with the score before surgery, which indicates that laparoscopic surgery intreating castration-resistant prostate cancer invading bilateral ureteral orifices is safe and effective, it could not only reduce tumor loading, solve complications such as urinary retention and renal failure, but also significantly improve urination function and quality of life. Hence, further clinical trials with further followup and larger sample size are worth of trying to confirm this result.

收稿日期：2021-12-06 录用日期：2022-03-14

Received Date: 2021-12-06 Accepted Date: 2022-03-14

基金项目：徐州市科技创新项目（KC20054）

Foundation Item: Science and Technology Innovation Project of Xuzhou City (KC20054)

通讯作者：王军起，Email：469601418@qq.com

Corresponding Author: WANG Junqi, Email: 469601418@qq.com

引用格式：宋震，支乾通，韦付坤， 等. 机器人辅助腹腔镜治疗侵犯双侧输尿管开口去势抵抗性前列腺癌一例报道[J]. 机器人外科学杂志（中英文），2023，4（2）：171-176.

Citation: SONG Z, ZHI Q T, WEI F K, et al. Robot-assisted laparoscopic surgery in treatment of castration-resistant prostate cancer invading bilateral ureteral orifices: a case report [J]. Chinese Journal of Robotic Surgery, 2023, 4 (2): 171-176.

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

[2] Chen R, Ren S, Yiu M K, et al. Prostate cancer in Asia: A collaborative report[J]. Asian J Urol, 2014, 1(1): 15-29.

[3] 郭长城, 杨斌, 琚建军, 等. T4 期前列腺癌手术治疗的疗效分析[J]. 中华泌尿外科杂志, 2021, 42(9):700-705.

[4] Taitt H E. Global Trends and Prostate Cancer: a review of incidence, detection, and mortality as influenced by race, ethnicity, and geographic location[J]. Am J Mens Health, 2018, 12(6): 1807-1823.

[5] Tilki D, Pompe R S, Bandini M, et al. Local treatment for metastatic prostate cancer: a systematic review[J].Int J Urol, 2018, 25(5): 390-403.

[6] Sooriakumaran P, Nyberg T, Akre O, et al. Survival among men at high risk of disseminated prostate cancer receiving initial locally directed radical treatment or initial androgen deprivation therapy[J]. Eur Urol, 2017,72(3): 345-351.

[7] Dellis A, Zagouri F, Liontos M, et al. Management of advanced prostate cancer: a systematic review of existing guidelines and recommendations[J]. Cancer Treat Rev, 2019, 73(2): 54-61.

[8] Hajili T, Ohlmann C H, Linxweiler J, et al. Radical prostatectomy in T4 prostate cancer after inductive androgen deprivation: results of a single-institution series with long-term follow-up[J].BJU Int, 2019, 123(1):58-64.

[9] 贾卓敏, 马鑫, 艾星, 等. 达芬奇机器人手术系统在泌尿外科手术中的优势[J]. 现代泌尿外科杂志,2018, 23(5): 328-331.

[10] Chang A J, Autio K A, Roach M 3rd, et al. High-risk prostate cancer: classification and therapy[J].Nat Rev Clin Oncol, 2014, 11(6): 308-323.