腹腔镜与机器人辅助根治性前列腺切除术的手术时间和失血量对手术切缘及功能结局的影响：一项前瞻性分析
Influence of operative time and blood loss on surgical margins and functional outcomes for laparoscopic versus robotic-assisted radical prostatectomy: a prospective analysis.
作者信息
Salciccia Stefano, Rosati Davide, Viscuso Pietro, Canale Vittorio, Scarrone Emiliano, Frisenda Marco, Catuzzi Roberta, Moriconi Martina, Asero Vincenzo, Signore Stefano, De Dominicis Mauro, Emiliozzi Paolo, Carbone Antonio, Pastore Antonio Luigi, Fuschi Andrea, Di Pierro Giovanni Battista, Gentilucci Alessandro, Cattarino Susanna, Mariotti Gianna, Busetto Gian Maria, Ferro Matteo, De Berardinis Ettore, Ricciuti Gian Piero, Panebianco Valeria, Magliocca Fabio Massimo, Del Giudice Francesco, Maggi Martina, Sciarra Alessandro
机构信息
Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy.
Department of Urology, S. Eugenio Hospital, ASL Rome 2, Rome, Italy.
出版信息
Cent European J Urol. 2021;74(4):503-515. doi: 10.5173/ceju.2021.0177. Epub 2021 Nov 29.
INTRODUCTION
The aim of this article was to analyze whether operative time and blood loss during radical prostatectomy (RP) can significantly influence surgical margins (SM) status and post-operative functional outcomes.
MATERIAL AND METHODS
We prospectively analyzed prostate cancer (PC) patients undergoing RP, using robot-assisted (RARP) or laparoscopic (LRP) procedures. Blood loss was defined using the variation in hemoglobin (Hb, g/dl) values from the day before surgery and no later than 4 hours after surgery.
RESULTS
From a whole population of 413 cases considered for RP, 67% underwent LRP and 33.0% RARP. Positive SM (SM+) were found in 33.9% of cases. Mean surgical operative time was 172.3 ±76 min (range 49-485), whereas blood loss was 2.3 ±1.2 g/dl (range 0.3-7.6). Operative time and blood loss at RP were not significantly correlated (r = -0.028275; p = 0.684). SM+ rates significantly (p = 0.002) varied by operative time; a higher SM+ rate was found in cases with an operative time <120 min (41.2%) and >240 min (53.4%). The risk of SM+ significantly increased 1.70 and 1.94 times in cases with an operative time <120 min and >240 min, respectively, independently to the surgical approach. The rate of erectile disfunction (ED) varied from 22.4% to 60.3% between <120 min and >240 min procedures (p = 0.001). According to blood loss, SM+ rates slightly but significantly (p = 0.032) varied; a higher rate of SM+ was found in cases with a Hb variation between 2-4 g/dl (35.9%).
CONCLUSIONS
Independently to the surgical approach, operative time, more than blood loss at RP, represents a significant variable able to influence SM status and post-operative ED.
引言
本文旨在分析根治性前列腺切除术（RP）期间的手术时间和失血量是否会显著影响手术切缘（SM）状态及术后功能结局。
材料与方法
我们前瞻性分析了接受RP的前列腺癌（PC）患者，采用机器人辅助（RARP）或腹腔镜（LRP）手术方式。失血量通过手术前一天至手术后不超过4小时血红蛋白（Hb，g/dl）值的变化来定义。
结果
在考虑进行RP的413例患者中，67%接受了LRP，33.0%接受了RARP。33.9%的病例发现手术切缘阳性（SM+）。平均手术时间为172.3±76分钟（范围49 - 485分钟），而失血量为2.3±1.2 g/dl（范围0.3 - 7.6）。RP时的手术时间和失血量无显著相关性（r = -0.028275；p = 0.684）。SM+率因手术时间而有显著差异（p = 0.002）；手术时间<120分钟（41.2%）和>240分钟（53.4%）的病例中SM+率更高。手术时间<120分钟和>240分钟的病例中，SM+风险分别显著增加1.70倍和1.94倍，与手术方式无关。勃起功能障碍（ED）发生率在手术时间<120分钟和>240分钟的手术之间从22.4%至60.3%不等（p = 0.001）。根据失血量，SM+率有轻微但显著的差异（p = 0.032）；血红蛋白变化在2 - 4 g/dl的病例中SM+率更高（35.9%）。
结论
与手术方式无关，RP时的手术时间比失血量更能显著影响SM状态和术后ED。
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