机器人外科学杂志（中英文）2025，Vol.6Issue(7)：1115-1121,7.DOI:10.12180/j.issn.2096-7721.2025.07.007
机器人辅助腹腔镜根治性前列腺切除术不同手术入路的疗效对比及术后肠梗阻危险因素分析(附手术视频)
Comparison of surgical approaches and analysis of postoperative ileus risk factors in robot-assisted laparoscopic radical prostatectomy(with surgical video)
摘要
Abstract
Objective:To investigate the efficacy of different surgical approaches in Da Vinci robot-assisted laparoscopic radical prostatectomy(RARP)and the risk factors associated with postoperative ileus(POI).Methods:A retrospective analysis was conducted on 114 patients who underwent RARP at Wuhan No.1 Hospital from June 2022 to December 2023.Based on the surgical approach,patients were divided into the observation group(n=57,posterior bladder approach)and the control group(n=57,anterior bladder approach).All patients were followed up for at least one year.Surgical outcomes and urinary continence recovery were compared between the two groups.Logistic regression was used to analyze the influencing factors of POI after RARP,and ROC curves were employed to evaluate the predictive accuracy of relevant variables.Results:There were no significant differences between the two groups in terms of operative time,intraoperative blood loss,postoperative hospital stay,catheter induration time,bed rest duration,or positive surgical margin rate(P>0.05).The observation group showed higher urinary continence recovery rates immediately after catheter removal and at 3 months postoperatively compared to the control group(P<0.05),but no significant differences were observed at 6 and 12 months(P>0.05).Among the 114 patients,11(9.65%)developed POI.Multivariate Logistic regression analysis revealed that intraoperative blood loss,postoperative TNF-α levels,postoperative hospital stay,comorbid heart disease,and preoperative chemotherapy were independent risk factors for POI,while preoperative WBC count and postoperative serum albumin(ALB)levels were protective factors(P<0.05).ROC curve analysis demonstrated that intraoperative blood loss,postoperative TNF-α levels,postoperative hospital stay,postoperative serum ALB,and preoperative WBC count had predictive value for POI(P<0.05).Conclusion:Both anterior and posterior bladder approaches in Da Vinci robot-assisted laparoscopic radical prostatectomy allow rapid postoperative recovery,but the posterior approach offers better early urinary continence outcomes.Intraoperative blood loss,postoperative TNF-α levels,prolonged hospital stay,comorbid heart disease,and preoperative chemotherapy are independent risk factors for POI,while preoperative WBC count and postoperative serum ALB levels are protective factors.Clinicians should prioritize these factors and implement proactive preventive measures to reduce POI risk and enhance postoperative recovery.关键词
机器人辅助手术/前列腺癌/手术入路/根治性前列腺切除术/肠梗阻Key words
Robot-assisted Surgery/Prostate Cancer/Surgical Bladder Approach/Radical Prostatectomy/Intestinal Obstruction分类
医药卫生引用本文复制引用
汪婷,胡宇,郑福鑫,周高峰..机器人辅助腹腔镜根治性前列腺切除术不同手术入路的疗效对比及术后肠梗阻危险因素分析(附手术视频)[J].机器人外科学杂志（中英文）,2025,6(7):1115-1121,7.基金项目
武汉市知识创新专项项目(2022020801020533)Wuhan Knowledge Innovation Special Project(2022020801020533) （2022020801020533）
