經尿道攝護腺刮除術後對攝護腺癌病患接受機械手臂輔助腹腔鏡攝護腺根除術術後結果研究

Outcomes of Robotic-Assisted Laparoscopic Radical Prostatectomy After Previous Transurethral Resection of the Prostate: a Match-paired Controlled Study

洪啟峰(Chi-Feng Hung)

指導教授 ： 周明智

中山醫學大學/醫學院/醫學研究所/碩士(2015年)

https://doi.org/10.6834/CSMU.2015.00111

摘要

研究背景：
攝護腺癌是影響男性重要的癌症之一。恥骨後攝護腺癌根除術（Retropubic Radical Prostatectomy, RRP）至今仍是侷限性攝護腺癌的標準治療。良性攝護腺增生（Benign Prostate Hyperplasia, BPH）的病患接受經尿道攝護腺切除術(Transurethral Resection of the Prostate, TURP)的標本中約有3-16%會意外發現惡性腫瘤，本研究則在探討曾接受經尿道攝護腺刮除術後對攝護腺癌病患後續接受機械手臂輔助腹腔鏡攝護腺根除術(Robotic-Assisted Laparoscopic Radical Prostatectomy, RALP)的結果。
材料與方法 :
本研究回溯性收集台中榮民總醫院從2005年12月至2014年3月，共730例患者接受機械手臂輔助腹腔鏡攝護腺根除術，其中73例（10％）此前曾接受經尿道攝護腺切除術。另外收集一組也是73例的配對病例對照(Matched-Pair Control)。配對變數包括年齡，身體質量指數(Body Mass Index, BMI)，攝護腺大小，臨床分期，血清攝護腺特定抗原(Prostate Specific Antigen, PSA)，攝護腺切片格里森分數(Gleason score)。
結果 :
曾接受TURP的患者有較高的機會需要膀胱頸重建（93.75% vs. 15.21%, p<0.001），較長的術後住院時間（4.12 vs. 3.04, p=0.007），以及較小的標本體積（32.56% vs. 42.61%, p<0.001）。平均控制台時間，失血量，輸血比率，及術後導尿管留置的時間兩組並無統計學上的差異。曾接受TURP的患者，12個月的禁尿率為94.5％，以前沒有TURP 的患者則為97.2％（P=0.681）。術中成功保留神經血管束和術後12個月勃起功能的比率兩組也無統計學差異。
結論 :
機械手臂輔助腹腔鏡攝護腺根除術對曾接受經尿道攝護腺刮除術的病患是可行的手術。而手術結果，短期腫瘤控制，禁尿功能及勃起功能結果與未曾接受經尿道攝護腺刮除術的病患相當。

關鍵字

攝護腺腫瘤 ； 機械手臂輔助腹腔鏡攝護腺根除術 ； 機械手臂 ； 經尿道攝護腺切除術

並列摘要

Purpose: The aim of our study was to investigate the effect of previous transurethral resection of the prostate (TURP) on the outcomes of robotic-assisted laparoscopic radical prostatectomy (RALP).
Methods: From December 2005 to March 2014, 730 patients underwent RALP, of whom 73 (10%) had previously undergone TURP. Data were retrospectively collected with the same number of match-paired controls (without previous TURP). Matching variables included age, body mass index, prostate size, clinical stage, serum prostate specific antigen level, and biopsy Gleason score.
Results: The patients who had previously undergone TURP had a significantly greater need for bladder neck reconstruction (93.75% vs. 15.21%, p<0.001), longer postoperative hospital stay (4.12 vs. 3.04, p=0.007), and smaller specimen volume (32.56% vs. 42.61%, p<0.001). Mean console time, estimated blood loss, transfusion rate, and duration of urethral catheterization were statistically similar between the groups. Although there were more bowel injuries and a higher rate of major complications in those with previous TURP, the differences did not reach statistical significance. The 12-month continence rate was 94.5% in those with previous TURP and 97.2% in those without previous TURP (p=0.681). There were no statistical differences in the successful preservation of neurovascular bundles and potency rates at 12 months of follow-up.
Conclusions: RALP for prostate cancer in patients who have previously undergone TURP is a feasible procedure with comparable perioperative, short-term oncological, and functional results to those of naive cases.

並列關鍵字

prostatic neoplasm ； robotic-assisted laparoscopic prostatectomy (RALP) ； robotics ； transurethral resection of prostate (TURP)

參考文獻

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