Cancer Center, Gamma Knife Treatment Center, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China.
Graduated School, Zhejiang Chinese Medical University, Hangzhou, 310014, Zhejiang, China.
BMC Urol. 2024 Apr 20;24(1):92. doi: 10.1186/s12894-024-01462-3.
This study aimed to investigate the effects of two different positions on lower extremity hemodynamics during robot-assisted laparoscopic radical prostatectomy (RARP) for prostate cancer.
A total of 196 patients who underwent RARP in our hospital from February 2020 to March 2022 were included in this study. Among them, 98 patients who underwent surgery with the Trendelenburg position and split-leg position with calf reverse arch from March 2021 to March 2022 were assigned to the observation group, while 98 patients who underwent surgery with the Trendelenburg position and low lithotomy position from February 2020 to February 2021 were assigned to the control group. Using an ultrasound diagnostic instrument to detect the internal diameter, mean blood flow velocity, and mean blood flow volume of the left deep femoral vein at different times, such as the supine position (T0), after 5 minutes of placing the patient in the leg spilt or low lithotomy position (T1), after 5 minutes of pneumoperitoneum (T2), after 5 minutes of head-down tilt or head-down tilt and calf reverse arch (T3), 1.5 hours after the start of surgery (T4), before the removal of CO2 gas (T5), and before the patient left the operating room (T6). As well as the patency of deep venous blood flow in both lower extremities before leaving the operating room, RESULTS: After establishment of pneumoperitoneum, the internal diameter of the deep femoral vein increased significantly, while the mean blood flow velocity and mean blood flow volume decreased significantly in both groups(T0) (P<0.001). With the prolongation of surgical time, the impact on lower extremity hemodynamics in the observation group was smaller than that in the control group. From T2 to T6, the internal diameter of the femoral vein in the observation group was smaller than that in the control group, while the mean blood flow velocity and mean blood flow volume were increased compared to the control group (P<0.05). Before leaving the operating room, the patency of deep venous blood flow in the observation group was better than that in the control group (P=0.003).
Placing patients in the Trendelenburg position and split-leg position with calf reverse arch during RARP for prostate cancer has a smaller impact on lower extremity hemodynamics than the low lithotomy position, and can relatively reduce the risk of postoperative deep vein thrombosis.
本研究旨在探讨机器人辅助腹腔镜前列腺癌根治术（RARP）中两种不同体位对下肢血液动力学的影响。
本研究纳入了 2020 年 2 月至 2022 年 3 月在我院接受 RARP 的 196 例患者。其中，2021 年 3 月至 2022 年 3 月采用臀高截石位和小腿反向拱位的 98 例患者被分配到观察组，而 2020 年 2 月至 2021 年 2 月采用臀高截石位和低截石位的 98 例患者被分配到对照组。使用超声诊断仪在不同时间（仰卧位 T0、放置腿分开或低截石位后 5 分钟 T1、气腹后 5 分钟 T2、头低脚高位或头低脚高位和小腿反向拱位后 5 分钟 T3、手术开始后 1.5 小时 T4、二氧化碳气体去除前 T5 和患者离开手术室前 T6）检测左股深静脉的内径、平均血流速度和平均血流体积，以及手术前离开手术室时双侧下肢深静脉血流的通畅性。
气腹建立后，两组深股静脉内径明显增大，平均血流速度和平均血流体积均明显下降（T0）（P<0.001）。随着手术时间的延长，观察组对下肢血液动力学的影响小于对照组。从 T2 到 T6，观察组股静脉内径小于对照组，平均血流速度和平均血流体积均高于对照组（P<0.05）。离开手术室前，观察组深静脉血流通畅性优于对照组（P=0.003）。
在前列腺癌的 RARP 中，患者采用头低脚高位和小腿反向拱位的体位对下肢血液动力学的影响小于低截石位，可以相对降低术后深静脉血栓形成的风险。
