经尿道前列腺切除术后机器人前列腺癌根治术的临床应用

Clinical application of robot-assisted radical prostatectomy after transurethral partial prostatectomy

摘要

目的: 总结经尿道前列腺部分切除术后行机器人辅助根治性前列腺切除术（RARP）的临床经验。方法 收集 2021年9月至2025年2月收治的 30 例患者的临床资料,患者行经尿道前列腺部分切除术（电切术或剜除术）后确诊前列腺癌,再次行 RARP。RARP 术前行经尿道前列腺电切术 10 例、经尿道前列腺剜除术 20 例。电切/揢除术至 RARP 手术的等待时间为 3 个月至 2 年。手术采用经腹膜外入路。结果 30 例患者均顺利完成手术。 24 例病理报告提示肿瘤残留或细胞呈泡沫样改变, 6 例提示前列腺增生合并前列腺炎; 1 例患者病理提示切缘阳性。术后 6 周复查总前列腺特异性抗原,均降至 0.02ng/mL以下。尿控恢复情况：拔除导尿管 1 周时,5 例患者恢复控尿;术后 1 个月时, 10 例患者恢复控尿;术后 3 个月时, 25例患者恢复控尿。 6 例患者术后发生尿道狭窄,经尿道扩张 4~6 次后排尿恢复正常。结论 经尿道前列腺部分切除术后行 RARP 具有特殊性,术前需充分评估患者前列腺周围情况、术中精细操作、术后加强管理,以保证手术的安全性与有效性。

Abstract

Objective: To summarize the clinical experience of robot-assisted radical prostatectomy（RARP）after transurethral partial prostatectomy. Methods: The clinical data of 30 patients admitted from Sep. 2021 to Feb. 2025 were collected.All patients were diagnosed with prostate cancer after transurethral partial prostatectomy（transurethral resection of the prostate or transurethral enuclea- tion of the prostate）and then underwent RARP again.Before RARP, 10 patients had undergone transurethral resection of the prostate, and 20 patients had undergone transurethral enucleation of the prostate.The interval between transurethral resection/enucleation and RARP ranged from 3 months to 2 years.All operations were performed via the extraperitoneal approach. Results: All 30 patients successfully completed the operation.The pathological reports of 24 patients indicated tumor residue or foamy cell changes, and 6 patients indicated benign prostatic hyperplasia complicated with prostatitis.Pathological examination of one patient indicated positive resection margin.The total prostate-specific antigen of all patients was reexamined 6 weeks after operation, and all decreased to below 0.02ng/mL.Recovery of urinary control： 1 week after urinary catheter removal, 5 patients regained urinary control; 1 month after opera- tion, 10 patients regained urinary control; 3 months after operation, 25 patients regained urinary control.Urethral stricture occurred in 6 patients after operation, and urination returned to normal after 4 to 6 times of transurethral dilation. Conclusions: RARP after transure- thral partial prostatectomy has particularities.Adequate preoperative evaluation of the periprostatic conditions of patients, meticulous intr- aoperative operation, and strengthened postoperative management are required to ensure the safety and effectiveness of the operation.

关键词

前列腺肿瘤 / 前列腺癌根治术 / 机器人手术 / 膀胱颈重建 / 经尿道前列腺部分切除术 / 前列腺剜除术 / 前列腺电切术

Key words

Prostatic neoplasms / Radical prostatectomy / Robotic surgical procedures / Bladder neck reconstruction / Transure-thral partial prostatectomy / Enucleation of the prostate / Transurethral resection of the prostate

[1] 温超宁,李励献,林国伟.经尿道前列腺切除术后前列腺偶发癌的单中心发病率和相关因素分析[J].基层医学论坛, 2025,29（12）:44-46,50.
[2] 胡宇宁,张琦.前列腺偶发癌的治疗进展[J].浙江临床医学,2023,25(4):620-622.
[3] 姚璇,刘波,王黎,等.前列腺偶发癌 9 例临床分析[J].临床外科杂志,2023,31(4):380-382.
[4] Porcaro AB,Tafuri A,Inverardi D,et al.Incidental prostate cancer after transurethral resection of the prostate:analysis of inci- dence and risk factors in 458 patients[J].Minerva Urol Nephrol,2021,73(4):471-480.
[5] Di Bello F,Scheipner L,Baudo A,et al.Cancer-specific mortality after radical prostatectomy versus radiotherapy in incidental prostate cancer[J].Urol Oncol,2025,43(6):397.e1-397.e7.
[6] 曲发军,丁杰,虞永江,等.双边尿道前悬吊联合筋膜内切除技术促进机器人辅助根治性前列腺切除术后早期尿控恢复的临床应用[J].临床泌尿外科杂志,2024,39(8):679-683,688.
[7] Yilmaz M,Toprak T,Suarez-Ibarrola R,et al.Incidental prostate cancer after holmium laser enucleation of the prostate-A narrative review[J].Andrologia,2022,54(3):e14332.
[8] Hilscher M,Røder A,Helgstrand JT,et al.Risk of prostate cancer and death after benign transurethral resection of the prostate-A 20-year population-based analysis[J].Cancer,2022,128(20):3674-3680.
[9] Leni R,Vickers AJ,Brasso K,et al.Management and Oncologic Outcomes of Incidental Prostate Cancer After Transurethral Resection of the Prostate in Denmark[J].J Urol,2024,212(5):692-700.
[10] Artiles Medina A,Tagalos Muñoz A,Domínguez Gutiérrez A,et al.Outcomes of Active Treatment for Localised Prostate Cancer After Holmium Laser Enucleation of the Prostate:A Systematic Review and Meta-analysis[J].Eur Urol Open Sci,2025,79:111-127.
[11] 吴奔,周睿,鲍形,等.不同经尿道前列腺切除术治疗良性前列腺增生的疗效与安全性分析[J].实用医学杂志,2024,40(22):3202-3207.
[12] Han JH,Chung DH,Cho MC,et al.Natural history of incidentally diagnosed prostate cancer after holmium laser enucleation of the prostate[J].PLoS One,2023,18(2):e0278931.
[13] Gu L,Li Y,Li X,et al.Does previous transurethral resection of the prostate negatively influence subsequent robotic-assisted radi- cal prostatectomy in men diagnosed with prostate cancer?A systematic review and meta-analysis[J].J Robot Surg,2023,17(4): 1299-1307.
[14] Skrupskiy KS,Kolontarev KB,Medvedev RM,et al.Robot-assisted radical prostatectomy in patients after transurethral resection of the prostate[J].Urologiia,2024,(1):119-122.
[15] Tappero S,Vecchio E,Palagonia E,et al.Retzius-sparing robot-assisted radical prostatectomy after previous trans-urethral resec- tion of the prostate:Assessment of functional and oncological outcomes[J].Eur J Surg Oncol,2023,49(8):1524-1535.
[16] 徐雨来,夏中友,王浩.前列腺癌根治术中膀胱颈重建技术的研究进展[J].西部医学,2023,35(6):932-936.
[17] Hu A,Lin Y,Zhu X,et al.Does transurethral resection of the prostate before robot-assisted radical prostatectomy have adverse effects on patients diagnosed with prostate cancer:a comparative evidence-based analysis?[J].J Robot Surg,2025,19(1):74.
[18] Jaber AR,Moschovas MC,Noel J,et al.Does previous transurethral resection of the prostate affect the outcomes in robotic assis- ted radical prostatectomy?[J].World J Urol,2024,42(1):384.
[19] Bajpai RR,Razdan S,Sanchez-Gonzalez MA,et al.Robot-Assisted Radical Prostatectomy After Prior Transurethral Resection of Prostate:An Analysis of Perioperative,Functional,Pathologic,and Oncologic Outcomes[J].J Endourol,2022, 36（8):1063-1069.
[20] Carbin DD,Chedid WA,Hindley R,et al.Outcomes of robot-assisted radical prostatectomy in men after trans-urethral resection of the prostate:a matched-pair analysis[J].J Robot Surg,2024,18(1):158.
[21] Cheng BKC,Castellani D,Chan IS,et al.Incidence,predictive factors and oncological outcomes of incidental prostate cancer after endoscopic enucleation of the prostate:a systematic review and meta-analysis[J].World J Urol,2022,40(1):87-101.

基金资助

上海市创新医疗器械示范应用项目（23SHS04600）;宝山区卫生健康委优青（育才）计划（BSWSYC-2024-16）;上海市宝山区科学委员会面上项目（2024-E-40）