机器人辅助腹腔镜与常规腹腔镜前列腺癌根治术疗效对比及影响因素分析

陈启铭; 陈剑; 刘秋礼; 张尧; 张军; 舒泽华; 王洛夫; 兰卫华; 江军

doi:10.16016/j.2097-0927.202404045

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机器人辅助腹腔镜与常规腹腔镜前列腺癌根治术疗效对比及影响因素分析

临床医学 | 更新时间：2026-01-09

- 机器人辅助腹腔镜与常规腹腔镜前列腺癌根治术疗效对比及影响因素分析
- Comparison of efficacy between robot-assisted laparoscopic and conventional laparoscopic radical prostatectomy and analysis on influencing factors
- 陆军军医大学学报 2024年46卷第21期页码：2424-2431
- 作者机构：
  
  400010 重庆，陆军特色医学中心泌尿外科
- 作者简介：
  
  [江军，E-mail: jiangjun_64@163.com JIANG Jun, E-mail: jiangjun_64@163.com
- 基金信息：
  
  国家自然科学基金面上项目(82372758);国家自然科学基金面上项目(82172807)
- DOI：10.16016/j.2097-0927.202404045
  中图分类号： R616;R730.56;R737.25
- 收稿：2024-04-12，
  
  修回：2024-06-03，
  
  纸质出版：2024-11-15
- 稿件说明：
移动端阅览
陈启铭, 陈剑, 刘秋礼, 等. 机器人辅助腹腔镜与常规腹腔镜前列腺癌根治术疗效对比及影响因素分析[J]. 陆军军医大学学报, 2024,46(21):2424-2431.

Qiming CHEN, Jian CHEN, Qiuli LIU, et al. Comparison of efficacy between robot-assisted laparoscopic and conventional laparoscopic radical prostatectomy and analysis on influencing factors[J]. Journal of Army Medical University, 2024, 46(21): 2424-2431.
陈启铭, 陈剑, 刘秋礼, 等. 机器人辅助腹腔镜与常规腹腔镜前列腺癌根治术疗效对比及影响因素分析[J]. 陆军军医大学学报, 2024,46(21):2424-2431. DOI： 10.16016/j.2097-0927.202404045.

Qiming CHEN, Jian CHEN, Qiuli LIU, et al. Comparison of efficacy between robot-assisted laparoscopic and conventional laparoscopic radical prostatectomy and analysis on influencing factors[J]. Journal of Army Medical University, 2024, 46(21): 2424-2431. DOI： 10.16016/j.2097-0927.202404045.

摘要

目的

探究比较机器人辅助下腹腔镜与常规腹腔镜前列腺癌根治术的术后疗效，并分析影响疗效的因素。

方法

本研究采用回顾性队列研究方法，收集陆军特色医学中心泌尿外科2002年6月至2023年10月行前列腺癌根治术的患者719例(总队列)，根据手术方式的不同分为2组：机器人辅助腹腔镜前列腺癌根治术组(机器人组，

=409)和普通腹腔镜前列腺癌根治术组(普通组，

=310)。比较2组的临床特征，生化复发率，术后1、3、6、12个月尿控恢复率，术后6、12个月的性功能恢复情况，并分析总队列中生化复发、尿控恢复的影响因素。

结果

本中心机器人组患者分期更晚，高病理T分期占比高(≥pT3分期，

＜0.01)、淋巴结阳性率更高(

＜0.01)；并且机器人组在淋巴结清扫个数显著高于普通组(

＜0.01)。2组在病理Gleason评分、生化复发率、并发症发生率、并发症类型的差异无统计学意义。在术后1个月(

=0.004)、3个月(

＜0.01)、6个月(

=0.002)、12个月(

=0.004)的尿控恢复率方面，机器人组患者显著高于普通组。在术后6个月、12个月的国际勃起功能指数问卷表-5(International Index of Erectile Function-5

IIEF-5)评分方面，机器人组患者性功能恢复与普通组无统计学差异。在总队列中，高病理T分期(≥pT3分期，

＜0.01)、高病理Gleason评分(＞7分，

=0.036)、淋巴结清扫个数少(≤10个，

＜0.01)、淋巴结阳性(

=0.046)是生化复发的独立危险因素；并且手术方式(机器人辅助腹腔镜前列腺癌根治术)是术后12个月尿控恢复的影响因素(

=0.005)。

结论

与普通腹腔镜前列腺癌根治术相比，机器人辅助腹腔镜前列腺癌根治术在一定程度上能降低患者的生化复发率，并且能够提高前列腺癌患者在术后1、3、6、12个月时的尿控恢复率。

Abstract

Objective

To compare the therapeutic efficacy of robot-assisted laparoscopic radical prostatectomy versus conventional laparoscopic radical prostatectomy

and analyze the factors influencing treatment outcomes.

Methods

A retrospective cohort study was conducted on 719 patients (total cohort) who underwent radical prostatectomy in our department from June 2002 to October 2023. According to different surgical methods

they were divided into robot-assisted laparoscopic radical prostatectomy group (robotic group

=409) and conventional laparoscopic radical prostatectomy group (conventional group

=310). Clinical chara

cteristics

biochemical recurrence rates

and recovery of urinary continence at 1

and 12 months postoperatively

as well as sexual function recovery at 6 and 12 months after surgery

were compared between the 2 groups. Additionally

the factors influencing biochemical recurrence and urinary continence recovery were analyzed across the entire cohort.

Results

In the cohort

the robot group demonstrated significantly larger proportions of pathological high T stages (≥pT3

0.01)

increased positive lymph node rate (

0.01)

and greater number of dissected lymph nodes (

0.01) than the conventional group. There were no statistical differences between the 2 groups in terms of Gleason score

biochemical recurrence rate

or incidence and type of complications. The robot group exhibited significantly higher rates of urinary continence recovery at 1 (

=0.004)

3 (

0.01)

6 (

=0.002) and 12 months (

=0.004) postoperatively. But no obvious difference was seen in the score of International Index of Erectile Function-5 (IIEF-5) between the 2 groups at 6 and 12 months. Across the entire cohort

pathological high T stage (≥pT3

0.01)

high Gleason score (

=0.036)

fewer lymph nodes dissected (≤10

0.01)

and positive lymph nodes (

=0.046) were independent risk factors for biochemical recurrence. Additionally

the surgical method

specifically robot-assisted laparoscopic radical prostatectomy

was identified as a significant factor influencing urinary continence recovery at 12 months postoperatively (

=0.005).

Conclusion

Compared to conventional laparoscopic radical prostatectomy

robot-assisted laparoscopic radical prostatectomy shows certain effect on reducing biochemical recurrence rate and enhancing recovery of urinary continence in prostate cancer patients at 1

6 and 12 months postoperatively.

关键词

Keywords

references

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