中文摘要：

目的 评价机器人辅助腹腔镜手术治疗高危前列腺癌的可行性及优势.方法 回顾性分析2010年3月至2014年12月行根治性前列腺切除术的69例高危前列腺癌（临床分期≥T3a期、PSA ≥20 μg/L或Gleason评分≥8）患者的临床资料.其中44例行机器人辅助腹腔镜下根治性前列腺切除术（robot-assisted laparoscopic radical prostatectomy,RALRP）,年龄50 ～82岁,平均（66.7±8.6）岁;初始PSA 3.6 ～48.8 μg/L,平均（23.1±11.2）μg/L;手术均采用经腹腔途径完成.25例行开放性耻骨后根治性前列腺切除术（open rctropubic radical prostatectomy,ORP）,年龄52 ～ 75岁,平均（64.3±5.9）岁;初始PSA 5.7～41.3 μg/L,平均（21.7±10.2）μg/L.两组患者的年龄、初始PSA、术前Gleason评分、临床分期比较差异均无统计学意义（P＞0.05）.结果 RALRP组无中转开放,均采用机器人手术系统顺利完成.RALRP组和ORP组的平均手术时间分别为（158 ±47） min和（152 ±42） min,病理切缘阳性率分别为20.5％和24.0％,差异均无统计学意义（P＞0.05）.RALRP组和ORP组的术中出血量分别为（328±254） ml和（674±302）ml,术后住院时间分别为（8.4±3.1）和（14.4 ±3.7）d,差异均有统计学意义（P＜0.05）.术后RALRP组出现漏尿2例、淋巴漏2例;ORP组出现漏尿4例、淋巴漏3例,差异无统计学意义（P＞0.05）.术后RALRP组和ORP组平均随访时间分别为25、27个月,RARLP组尿控恢复率（93.2％）显著高于ORP组（72.0％）,差异有统计学意义（P＜0.05）.RALRP组和ORP组分别有7例和4例生化复发,差异无统计学意义（P＞0.05）.结论 RALRP治疗高危前列腺癌安全、有效,与ORP比较出血量少,并发症少,住院时间短,肿瘤学结果相近,术后尿控恢复更好.

英文摘要：

Objective To evaluate the feasibility and advantages of robot-assisted laparoscopic radical prostatectomy （RALRP） in treating high-risk prostate cancer.Methods From Mar.2010 to Dec.2014,69 men with high-risk prostate cancer （clinical stage ≥ T3a,serum PSA ≥ 20 μg/L or biopsy Gleason score ≥8） underwent surgical treatment at our center.RALRP was performed in 44 cases,with a mean age of （66.7 ± 8.6） yrs （range：50 ～ 82） and a mean baseline PSA of （23.1 ± 11.2） μg/L （range：3.6-48.8）.Transperitoneal approach was adopted in all cases.Twenty-five patients were treated with ORP.The mean age was （64.3 ± 5.9） yrs （range：52-75） and baseline PSA was （21.7 ± 10.2） μg/L （range：5.7-41.3）.Baseline clinical features,including age,initial PSA,biopsy Gleason score and clinical staging,were comparable between two cohorts.Surgical outcomes after RALRP were analyzed and compared between groups.Results All RALRP procedures were successfully performed with da Vinci robotic system and there was no open conversion.Mean operation duration were similarly （158 ± 47）min for RALRP group and （152± 42）min for ORP group,respectively.The mean estimated blood loss and postoperative length of hospital stay in RALRP group were （328 ± 254） ml and （8.4 ± 3.1） days,both of which were significant lower than those in ORP group,（674 ± 302） ml and （14.4 ± 3.7） days.Two cases of urine leak and two of lymphatic leak occurred after RALRP,and a statistically insignificantly higher complication rate was observed for the ORP group,in which four of urine leak and three of lymphatic leak happened.The positive surgical margin rates of two groups were 20.5% and 24%,respectively.After the mean follow-up of 25 （RALRP） and 27 months （ORP）,continence rate was significantly higher in the RARLP group （93.2% vs.72.0%）.PSA failure was observed in seven RALRP cases （15.9%） and four ORP cases （16.0%）.Conclusion Compared with traditional ORP,RALRP shows significant a