机器人辅助腹腔镜根治性前列腺切除术中背静脉复合体的非温热分离和选择性缝扎：技术描述和结果。
Athermal division and selective suture ligation of the dorsal vein complex during robot-assisted laparoscopic radical prostatectomy: description of technique and outcomes.
机构信息
Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
出版信息
Eur Urol. 2011 Feb;59(2):235-43. doi: 10.1016/j.eururo.2010.08.043. Epub 2010 Sep 15.
BACKGROUND
Apical dissection and control of the dorsal vein complex (DVC) affects blood loss, apical positive margins, and urinary control during robot-assisted laparoscopic radical prostatectomy (RALP).
OBJECTIVE
To describe technique and outcomes for athermal DVC division followed by selective suture ligation (DVC-SSL) compared with DVC suture ligation followed by athermal division (SL-DVC).
DESIGN, SETTINGS, AND PARTICIPANTS: Retrospective study of prospectively collected data from February 2008 to July 2010 for 303 SL-DVC and 240 DVC-SSL procedures.
SURGICAL PROCEDURE
RALP with comparison of DVC-SSL prior to anastomosis versus early SL-DVC prior to bladder-neck dissection.
MEASUREMENTS
Blood loss, transfusions, operative time, apical and overall positive margins, urine leaks, catheterization duration, and urinary control at 5 and 12 mo evaluated using 1) the Expanded Prostate Cancer Index (EPIC) urinary function scale and 2) continence defined as zero pads per day.
RESULTS AND LIMITATIONS
Men who underwent DVC-SSL versus SL-DVC were older (mean: 59.9 vs 57.8 yr, p<0.001), and relatively fewer white men underwent DVC-SSL versus SL-DVC (87.5% vs 96.7%, p<0.001). Operative times were also shorter for DVC-SSL versus SL-DVC (mean: 132 vs 147 min, p<0.001). Men undergoing DVC-SSL versus SL-DVC experienced greater blood loss (mean: 184.3 vs 175.6 ml, p=0.033), and one DVC-SSL versus zero SL-DVC were transfused (p=0.442). Overall (12.2% vs 12.0%, p=1.0) and apical (1.3% vs 2.7%, p=0.361) positive surgical margins were similar for DVC-SSL versus SL-DVC. Although 5-mo postoperative urinary function (mean: 72.9 vs 55.4, p<0.001) and continence (61.4% vs 39.6%, p<0.001) were better for DVC-SSL versus SL-DVC, 12-mo urinary outcomes were similar. In adjusted analyses, DVC-SSL versus SL-DVC was associated with shorter operative times (parameter estimate [PE]±standard error [SE]: 16.84±2.56, p<0.001), and better 5-mo urinary function (PE±SE: 19.93±3.09, p<0.001) and continence (odds ratio 3.39, 95% confidence interval 2.07-5.57, p<0.001).
CONCLUSIONS
DVC-SSL versus SL-DVC improves early urinary control and shortens operative times due to fewer instrument changes with late versus early DVC control.
背景
在机器人辅助腹腔镜根治性前列腺切除术（RALP）中，尖部解剖和背静脉复合体（DVC）的控制会影响失血量、尖部阳性切缘和尿控。
目的
描述与 DVC 缝合结扎（SL-DVC）相比，无热 DVC 分离后选择性缝合结扎（DVC-SSL）的技术和结果。
设计、设置和参与者：回顾性研究，对 2008 年 2 月至 2010 年 7 月前瞻性收集的数据进行分析，共纳入 303 例 SL-DVC 和 240 例 DVC-SSL 手术。
手术
RALP，比较吻合前 DVC-SSL 与膀胱颈解剖前早期 SL-DVC。
测量
采用 1）扩展前列腺癌指数（EPIC）尿功能量表和 2）每天零垫定义的控尿，评估失血量、输血、手术时间、尖部和整体阳性切缘、尿漏、导尿管留置时间以及术后 5 个月和 12 个月的尿控。
结果和局限性
与 SL-DVC 相比，接受 DVC-SSL 的男性年龄更大（平均年龄：59.9 岁比 57.8 岁，p<0.001），接受 DVC-SSL 的白人男性相对较少（87.5%比 96.7%，p<0.001）。DVC-SSL 的手术时间也比 SL-DVC 短（平均 132 分钟比 147 分钟，p<0.001）。与 SL-DVC 相比，接受 DVC-SSL 的男性失血量更多（平均 184.3 毫升比 175.6 毫升，p=0.033），1 例 DVC-SSL 输血与 0 例 SL-DVC 输血（p=0.442）。DVC-SSL 与 SL-DVC 的总（12.2%比 12.0%，p=1.0）和尖部（1.3%比 2.7%，p=0.361）阳性手术切缘相似。尽管 DVC-SSL 术后 5 个月的尿功能（平均 72.9 比 55.4，p<0.001）和控尿（61.4%比 39.6%，p<0.001）优于 SL-DVC，但 12 个月的尿功能结果相似。在调整分析中，与 SL-DVC 相比，DVC-SSL 与较短的手术时间（参数估计[PE]±标准误差[SE]：16.84±2.56，p<0.001）和更好的 5 个月尿功能（PE±SE：19.93±3.09，p<0.001）和控尿（比值比 3.39，95%置信区间 2.07-5.57，p<0.001）相关。
结论
与 SL-DVC 相比，DVC-SSL 通过晚期而非早期控制 DVC 减少器械更换次数，从而改善早期尿控并缩短手术时间。
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