Pan Jun-Wei, Jin Xing-Wei, Luo Fang-Xiu, Jin Wei, Tu Wei-Chao, Zhang Xiang, Wang Xian-Jin, Huang Bao-Xing, Xu Da, Lu Guo-Liang, Zhao Yang, Shao Yuan
Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Gland Surg. 2020 Dec;9(6):2116-2124. doi: 10.21037/gs-20-813.
Beforehand transection and suturing (BTS) of the dorsal vascular complex (DVC), a novel technique in non-neurovascular bundle sparing (NVB-sparing) extraperitoneal laparoscopic radical prostatectomy (eLRP), had been proposed; this study aimed to evaluate this technique in clinical laparoscopic procedures.
Using this new technique, the DVC was transected and sutured after dissection of the pelvic fascia and before dissection of the prostate, especially before ligation of the bilateral prostatic pedicles. This study retrospectively analyzed the data of 90 non NVB-sparing eLRP patients [traditional technique (n=60) and BTS technique (n=30)].
The surgical time in the BTS technique group was 121.73±24.53 min, which was significantly shorter (P=0.0015) than the traditional technique group (144.12±39.68 min). The calculated blood loss in the traditional technique group was 388.45±232.78 mL, and 264.16±130.70 mL in the BTS technique group (P=0.0016). The estimated blood loss in the traditional technique group was 350.34±311.80 mL, which was significantly greater than the BTS technique group (250.33±145.31 mL, P=0.0422). The transfusion rate in the traditional technique group was significantly greater than the BTS technique group (15.00% . 0.00%; P=0.0266). The biochemical recurrence rate in traditional technique group was 48.33%, which was higher than in the BTS group (30.00%) (P=0.0465). There was no significant difference between the 2 groups with respect to the pre-operative hemoglobin (Hb) concentration, pre-operative hematocrit (HCT), post-operative Hb concentration, post-operative HCT, ΔHCT, pre-operative blood volume, rectal perforation, open conversion, apical capsule residue, false suture, post-operative bleeding, urinary leakage, re-operation, surgical site infection, post-operative stay, and emission time of urinary incontinence.
In managing the relationship between the DVC and prostate in patients undergoing non NVB-sparing eLRP, the BTS technique was shown to be more effective and safer than the traditional technique.
背侧血管复合体（DVC）预先横断与缝合（BTS）是一种保留非神经血管束（NVB）的腹膜外腹腔镜根治性前列腺切除术（eLRP）中的新技术；本研究旨在评估该技术在临床腹腔镜手术中的应用效果。
采用这项新技术，在盆腔筋膜分离后、前列腺分离前，特别是在双侧前列腺蒂结扎前，对DVC进行横断与缝合。本研究回顾性分析了90例未保留NVB的eLRP患者的数据[传统技术组（n = 60）和BTS技术组（n = 30）]。
BTS技术组的手术时间为121.73±24.53分钟，显著短于传统技术组（144.12±39.68分钟）（P = 0.0015）。传统技术组计算得出的失血量为388.45±232.78毫升，BTS技术组为264.16±130.70毫升（P = 0.0016）。传统技术组估计失血量为350.34±311.80毫升，显著多于BTS技术组（250.33±145.31毫升，P = 0.0422）。传统技术组的输血率显著高于BTS技术组（15.00% 对0.00%；P = 0.0266）。传统技术组的生化复发率为48.33%，高于BTS组（30.00%）（P = 0.0465）。两组在术前血红蛋白（Hb）浓度、术前血细胞比容（HCT）、术后Hb浓度、术后HCT、ΔHCT、术前血容量、直肠穿孔、中转开放、尖部包膜残留、假缝合、术后出血、尿漏、再次手术、手术部位感染、术后住院时间以及尿失禁发生时间方面无显著差异。
在未保留NVB的eLRP患者中处理DVC与前列腺的关系时，BTS技术比传统技术更有效、更安全。
