[机器人辅助与开放性单纯前列腺切除术并发症的多中心比较]
[Multicenter comparison of complications after robot-assisted and open simple prostatectomy].
作者信息
Hamann C, Naumann C-M, Addali M, Witt J H, Kollitsch L, Wagner C, Hamann M, Jünemann K P, Osmonov D
机构信息
Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein - Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland.
Klinik für Urologie, Kinderurologie und urologische Onkologie, Prostatazentrum Nordwest, St. Antonius Hospital Gronau GmbH, Gronau, Deutschland.
出版信息
Urologe A. 2020 May;59(5):565-572. doi: 10.1007/s00120-020-01141-9.
INTRODUCTION
Robot-assisted simple prostatectomy (RASP) is a relatively new minimally invasive procedure for surgical treatment to manage symptomatic, therapy-refractory benign prostate hyperplasia (BPH) in prostate volumes >80 cm. Thus, postoperative morbidity based on Clavien-Dindo and hematological parameters in RASP and open simple prostatectomy (OSP) procedures are examined.
PATIENTS AND METHODS
We retrospectively reviewed a total of 78 patients: 39 patients underwent RAPS and 39 OSP. The following parameters were statistically evaluated and compared: age, PSA value, prostate volume, ASA score, duration of hospital stay, operative time, Hb decrease on postoperative (po) day 1 and in the 5 five po days, CRP peak in the first 5 po days and transfusion rate.
RESULTS
The comparison between RASP and standard OSP showed no significant differences regarding the mean patient age (73 vs. 74 years; p =0.54), PSA values (7.7 vs. 10.7 ng/ml; p =0.17), ASA score (2.2 vs. 2.3; p =0.26) and prostate volume (130 vs. 113 cm; p =0.07). Patients in the RAPAE group had statistically significant longer surgery (178 vs. 110 min; p =<0.01) with a significantly smaller decrease in Hb on po day 1 (1.9 vs. 3.3 g/dl; p ≤0.01) and in the first 5 po days (2.4 vs. 4.2 g/dl; p ≤0.01), lower need for preserved blood (3% vs. 26%; p =0.01) and number of blood bags (0.1 vs. 1.3; p =0.01), a lower po Clavien-Dindo score (0.44 vs. 1.23; p =0.003) and lower CRP values (52 vs. 104 mg/l; p ≤0.01) in the first 5 po days.
CONCLUSION
RASP is a safe procedure that offers the advantage of reduced blood loss and blood bag consumption and rare complications due to the minimally invasive surgical method. The OSP group showed an increased occurrence of complications due to bleeding, leading to prolonged hospitalization and significantly increased need for blood transfusion. The lesser increase of CRP in RASP group is a result of the lower invasiveness of the robot-assisted procedure.
引言
机器人辅助单纯前列腺切除术（RASP）是一种相对较新的微创手术，用于治疗前列腺体积>80 cm、有症状且对治疗耐药的良性前列腺增生（BPH）。因此，我们研究了RASP和开放性单纯前列腺切除术（OSP）术后基于Clavien-Dindo分级的并发症及血液学参数。
患者与方法
我们回顾性分析了78例患者，其中39例行RASP，39例行OSP。对以下参数进行统计学评估和比较：年龄、前列腺特异性抗原（PSA）值、前列腺体积、美国麻醉医师协会（ASA）评分、住院时间、手术时间、术后第1天和术后5天血红蛋白（Hb）下降情况、术后前5天C反应蛋白（CRP）峰值及输血率。
结果
RASP与标准OSP相比，患者平均年龄（73岁 vs. 74岁；p = 0.54）、PSA值（7.7 ng/ml vs. 10.7 ng/ml；p = 0.17）、ASA评分（2.2 vs. 2.3；p = 0.26）和前列腺体积（130 cm vs. 113 cm；p = 0.07）差异均无统计学意义。RASP组手术时间显著更长（178分钟 vs. 110分钟；p < 0.01），术后第1天Hb下降幅度显著更小（1.9 g/dl vs. 3.3 g/dl；p≤0.01），术后前5天Hb下降幅度也更小（2.4 g/dl vs. 4.2 g/dl；p≤0.01），备血量需求更低（3% vs. 26%；p = 0.01），血袋数量更少（0.1 vs. 1.3；p = 0.01），术后Clavien-Dindo评分更低（0.44 vs. 1.23；p = 0.003），术后前5天CRP值更低（52 mg/l vs. 104 mg/l；p≤0.01）。
结论
RASP是一种安全的手术方式，由于其微创手术方法，具有减少失血和血袋消耗以及罕见并发症的优点。OSP组因出血导致并发症发生率增加，住院时间延长，输血需求显著增加。RASP组CRP升高幅度较小是机器人辅助手术侵袭性较低的结果。
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