Meeks Joshua J, Zhao Lee, Greco Kristin A, Macejko Amanda, Nadler Robert B
Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA.
Urology. 2009 Feb;73(2):323-7. doi: 10.1016/j.urology.2008.08.484. Epub 2008 Nov 20.
Robotic-assisted laparoscopic prostatectomy (RALP) is becoming widely used for the management of prostate cancer. Although prostate size does not affect operative times for RALP, the effect of a large median prostate lobe has not been described.
One hundred fifty-four men underwent RALP by one surgeon between 2005 and 2007. Patients were categorized into 2 groups based on the presence or absence of a large median prostate lobe identified during RALP. The RALP was divided into sections from bladder mobilization to vesicourethral anastomosis. Operative times and outcomes were recorded prospectively.
Of the 154 patients, 29 (18%) of the men had large median prostate lobes. Men with large median lobes were slightly older, but had similar prostate-specific antigen, body mass index, clinical and pathologic stage, biopsy and prostatectomy Gleason grade, tumor volumes, and surgical margin rate compared with men without median lobes. Yet, prostate weight, estimated blood loss, and hospital stay was significantly greater in men with large median lobes. The overall operative time for the RALP was greater in men with a large median lobe caused by an increased time required for posterior bladder neck and seminal vesicle dissection. There was no difference in complications such as urine leaks, bladder neck contractures, and migration of Hem-o-lok clips into the bladder. Continence at 3 and 6 months after RALP were not significantly different in men with large median lobes.
Despite equivalent oncological outcomes, we demonstrate a significant increase in operative times among men with large median lobes.
机器人辅助腹腔镜前列腺切除术（RALP）在前列腺癌治疗中的应用日益广泛。虽然前列腺大小不影响RALP的手术时间，但尚未有关于中叶较大对手术影响的描述。
2005年至2007年间，一名外科医生为154名男性实施了RALP手术。根据RALP手术中是否存在中叶较大情况将患者分为两组。将RALP手术从膀胱游离至膀胱尿道吻合分为多个阶段。前瞻性记录手术时间和结果。
154例患者中，29例（18%）存在中叶较大情况。中叶较大的男性年龄稍大，但与中叶正常的男性相比，其前列腺特异性抗原、体重指数、临床和病理分期、活检及前列腺切除Gleason分级、肿瘤体积和手术切缘率相似。然而，中叶较大的男性前列腺重量、估计失血量和住院时间明显更长。由于膀胱颈后部和精囊解剖所需时间增加，中叶较大的男性RALP总体手术时间更长。尿漏、膀胱颈挛缩和Hem-o-lok夹移位至膀胱等并发症无差异。RALP术后3个月和6个月时，中叶较大的男性控尿情况无显著差异。
尽管肿瘤学结果相当，但我们发现中叶较大的男性手术时间显著增加。
