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冷冻保存的胎盘组织同种异体移植物可加速机器人辅助根治性前列腺切除术后的控尿时间。

Cryopreserved placental tissue allograft accelerates time to continence following robot-assisted radical prostatectomy.

机构信息

John Wayne Cancer Institute, Santa Monica, CA, USA.

Providence Saint Joseph's Health, Portland, OR, USA.

出版信息

J Robot Surg. 2021 Dec;15(6):877-883. doi: 10.1007/s11701-020-01187-z. Epub 2021 Jan 11.

Abstract

Intra-operatively placed cryopreserved placental tissue allograft (CPTA) has shown promise in expediting the recovery urinary continence (UC) following robot-assisted radical prostatectomy (RARP). In this retrospective review of a prospectively maintained single-surgeon, single-institution RARP database, we compare three groups of patients: historical controls (C; N = 183 men) that received no allograft versus two different CPTA products (total CPTA N = 162 [A1 N = 81; A2 N = 81]). The CPTA product was intra-operatively placed as an onlay over the area of the neurovascular bundles during RARP. CPTA cases had significantly faster median time to UC (A1 = 1.4 months; A2 = 1.45 months) versus controls (1.64 months), p = 0.01. On multivariable analysis, use of A1 (HR 1.55, 95% CI [1.14-2.09], p = 0.005) and use of A2 (HR 1.53, CI [1.11-2.11], p = 0.01) were significantly associated with quicker return of UC. Older age (HR 0.97, CI [0.96-0.99], p = 0.001) and non-organ-confined clinical stage (HR 0.51, CI [0.26-1.0] p = 0.05), were significantly associated with slower return of UC. In a propensity score-matched analysis of 77 CPTA patients with sufficient follow-up versus controls, there was significantly less biochemical recurrence (BCR; p = 0.01). Our study indicates that CPTA use appears to accelerate time to UC in age- and performance status-matched men undergoing RARP without increased risk of BCR.

摘要

术中放置冷冻胎盘组织同种异体移植物(CPTA)已显示出在加速机器人辅助根治性前列腺切除术(RARP)后恢复尿控(UC)的潜力。在对前瞻性维护的单外科医生,单机构 RARP 数据库的回顾性审查中,我们比较了三组患者:历史对照组(C;N=183 名男性)未接受同种异体移植物与两种不同 CPTA 产品(总 CPTA N=162[A1 N=81;A2 N=81])。CPTA 产品在 RARP 期间作为覆盖物放置在神经血管束区域上。CPTA 病例 UC 的中位时间明显快于对照组(A1=1.4 个月;A2=1.45 个月),p=0.01。多变量分析显示,使用 A1(HR 1.55,95%CI [1.14-2.09],p=0.005)和使用 A2(HR 1.53,CI [1.11-2.11],p=0.01)与 UC 更快恢复显著相关。年龄较大(HR 0.97,CI [0.96-0.99],p=0.001)和非器官受限的临床分期(HR 0.51,CI [0.26-1.0],p=0.05)与 UC 恢复较慢显著相关。在对 77 名 CPTA 患者进行倾向评分匹配分析,随访时间足够,与对照组相比,生化复发(BCR)明显减少(p=0.01)。我们的研究表明,CPTA 的使用似乎可以加速年龄和表现状态匹配的男性接受 RARP 后 UC 的时间,而不会增加 BCR 的风险。

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