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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 許毓昭 | 內視鏡前列腺切除手術對治療前列腺肥大之成果報告 | 2015/4/29 下午 05:36:51 | 0 |
| 原 文 | 題 目 | Perioperative Outcomes of Robotic and Laparoscopic Simple Prostatectomy: A European–American Multi-institutional Analysis |
| 作 者 | Autorino, R., Zargar, H., Mariano, M. B. et al | |
| 出 處 | Eur Urol, 2014 | |
| 出版日期 | Accepted November 21, 2014 | |
| 評 論 |
今年度在歐洲泌尿科醫學會上最最熱門的話題之一，不外乎就是內視鏡手術前列腺切除在治療前列腺肥大的經驗分享了。而歐洲泌尿科雜誌刊登了這一篇大型的研究報告，正好可以為這個議題做一個總結。 膀胱內視鏡前列腺刮除手術(transurethra resection of prostate)向來是治療前列腺肥大的黃金準則，隨著器械的進步以及雷射切割汽化的使用，使得這項手術更加安全。較大的前列腺雖然不一定是手術的絕對禁忌症，有經驗的醫師的確可以克服大小的問題進行手術，但是相對的手術時間以及麻醉時間的延長都有可能增加病患的風險。也有可能使手術的效果打折扣。 內視鏡前列腺切除主要是針對較大的前列腺，以手術整顆挖除的概念來進行，比較不受前列腺大小限制，手術的效果也不因攝護線特別肥大而影響到手術結果。 這一個大型的研究網羅了歐洲以及美洲23個大型醫療機構，分析自2000年到2014年來，為治療前列腺肥大所進行的內視鏡前列腺切除或機器人輔助前列腺切除，總共有1330個病患接受此項手術。治療的前列腺大小平均是100立方公分，前列腺嚴重度皆在重度，而且尿流速小於5ml/s的病人。手術12個月後追蹤，病患的解尿速度，症狀指數皆有大幅的改善。同持相對於膀胱內視鏡前列腺刮除手術，內視鏡前列腺切除在手術時間，手術併發症，與失血量上並沒有明顯的差異。另外一般內視鏡與機器人輔助內視鏡手術，在有經驗的醫師操作下，都同樣可以達到效果。 對於大型的前列腺(80立方公分以上)，內視鏡前列腺切除提供了另外一個選擇。 |
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| abstract |
2000 and 2014 at 23 participating institutions in the Americas and Europe were included in this retrospective analysis. Intervention: Laparoscopic or robotic SP. Outcome measurements and statistical analysis: Demographic data and main perioperative outcomes were gathered and analyzed. A multivariable analysis was conducted to identify factors associated with a favorable trifecta outcome, arbitrarily defined as a combination of the following postoperative events: International Prostate Symptom Score <8, maximum flow rate >15 ml/s, and no perioperative complications. Results and limitations: Overall, 1330 consecutive cases were analyzed, including 487 robotic (36.6%) and 843 laparoscopic (63.4%) SP cases. Median overall prostate volume was 100 ml (range: 89–128). Median estimated blood loss was 200 ml (range: 150–300). An intraoperative transfusion was required in 3.5% of cases, an intraoperative complication was recorded in 2.2% of cases, and the conversion rate was 3%. Median length of stay was 4 d (range: 3–5). On pathology, prostate cancer was found in 4% of cases. Overall postoperative complication rate was 10.6%, mostly of low grade. At a median follow-up of 12 mo, a significant improvement was observed for subjective and objective indicators of BOO. Trifecta outcome was not significantly influenced by the type of procedure (robotic vs laparoscopic; p = 0.136; odds ratio [OR]: 1.6; 95% confidence interval [CI], 0.8–2.9), as operative time (p = 0.01; OR: 0.9; 95% CI, 0.9–1.0) and estimated blood loss ( p = 0.03; OR: 0.9; 95% CI, 0.9–1.0) were the only two significant factors. Retrospective study design, lack of a control arm, and limited follow-up represent major limitations of the present analysis. Conclusions: This study provides the largest outcome analysis reported for MISP for BOO/BPE. These findings confirm that SP can be safely and effectively performed in a minimally invasive fashion in a variety of healthcare settings in which specific surgical expertise and technology is available. MISP can be considered a viable surgical treatment in cases of large prostatic adenomas. The use of robotic technology for this indication can be considered in centers that have a robotic program in place for other urologic indications. Patient summary: Analysis of a large data set from multiple institutions shows that surgical removal of symptomatic large prostatic adenomas can be carried out with good outcomes by using robot-assisted laparoscopy. |
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