Tsubouchi Kazuna, Gunge Naotaka, Tominaga Kosuke, Matsuzaki Hiroshi, Fujikawa Aiko, Emoto Taiki, Miyazaki Takeshi, Okabe Yu, Nakamura Nobuyuki, Kataoka Masao, Ogawa Soichiro, Akaihata Hidenori, Sato Yuichi, Hata Junya, Matsuoka Hirofumi, Kojima Yoshiyuki, Haga Nobuhiro
Department of Urology, Fukuoka University School of Medicine, Fukuoka, Japan.
Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan.
Int J Urol. 2022 Oct;29(10):1132-1138. doi: 10.1111/iju.14935. Epub 2022 May 23.
The aim of the present study was to clarify the relationships of intraoperative surgical position with the incidence of postoperative rhabdomyolysis and with postoperative renal function to safely perform robot-assisted radical prostatectomy.
The participants in the present study were 276 consecutive patients who underwent robot-assisted radical prostatectomy at our institutions between 2013 and 2020; 130 cases were performed in the opened legs position and 146 cases in the lithotomy position with a steep 23°-25° head-down position. Rhabdomyolysis was defined as creatine kinase values greater than 1000 IU/L. Propensity score matching including age, body mass index, the presence of comorbidities, preoperative creatine kinase, preoperative estimated glomerular filtration rate, and prostate-specific antigen was performed, resulting in a matched cohort of 146 patients (opened legs position group n = 73; lithotomy position group n = 73).
After propensity score matching, creatine kinase values on the first day after surgery were significantly lower in the opened legs position group than in the lithotomy position group (opened legs position group: lithotomy position group = 246.9 ± 114.9 IU/L: 558.2 ± 114.9 IU/L, P = 0.034). There were significantly fewer patients diagnosed with postoperative rhabdomyolysis in the opened legs position group (opened legs position group: lithotomy position group = 0% (0/73): 9.6% (7/73), P < 0.001). In addition, fluid replacement volume was significantly less in the opened legs position group (opened legs position group: lithotomy position group = 5747 ± 180 mL: 6349 ± 0176 mL, P = 0.018).
To prevent rhabdomyolysis after surgery, robot-assisted radical prostatectomy should be performed in the opened legs position.
本研究旨在阐明术中手术体位与术后横纹肌溶解症发生率以及与术后肾功能之间的关系，以安全地进行机器人辅助根治性前列腺切除术。
本研究的参与者为2013年至2020年间在我们机构连续接受机器人辅助根治性前列腺切除术的276例患者；130例采用分开双腿体位进行，146例采用截石位且头低23° - 25°的陡峭体位进行。横纹肌溶解症定义为肌酸激酶值大于1000 IU/L。进行了倾向评分匹配，包括年龄、体重指数、合并症的存在情况、术前肌酸激酶、术前估计肾小球滤过率和前列腺特异性抗原，最终形成了一个146例患者的匹配队列（分开双腿体位组n = 73；截石位组n = 73）。
倾向评分匹配后，分开双腿体位组术后第一天的肌酸激酶值显著低于截石位组（分开双腿体位组：截石位组 = 246.9 ± 114.9 IU/L：558.2 ± 114.9 IU/L，P = 0.034）。分开双腿体位组诊断为术后横纹肌溶解症的患者明显更少（分开双腿体位组：截石位组 = 0%（0/73）：9.6%（7/73），P < 0.001）。此外，分开双腿体位组的液体补充量显著更少（分开双腿体位组：截石位组 = 5747 ± 180 mL：6349 ± 176 mL，P = 0.018）。
为防止术后横纹肌溶解症，机器人辅助根治性前列腺切除术应采用分开双腿体位进行。
