So Sánh Phẫu Thuật Cắt Tuyến Tiền Liệt Tận Gốc Có Robot Hỗ Trợ Với Phẫu Thuật Nội Soi Tiêu Chuẩn: Kinh Nghiệm Tại Bệnh Viện Bình Dân

0 Người đánh giá. Xếp hạng trung bình 0

Tác giả: Anh Toàn Đỗ, Lệnh Hùng Đỗ, Nguyễn Minh Hoàng Lê, Ngọc Châu Nguyễn, Phúc Cẩm Hoàng Nguyễn, Phúc Minh Nguyễn, Tế Kha Nguyễn, Phú Phát Phạm, Kim Hồng Tăng, Đỗ Hữu Toàn Trần, Võ Anh Vinh Trang, Lê Chuyên Vũ

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y Dược học Phạm Ngọc Thạch, 2023

Mô tả vật lý: tr.99

Bộ sưu tập: Metadata

ID: 339148

Thêm vào giỏ Liên kết toàn văn

- Đặt vấn đề: Tại bệnh viện Bình Dân, cắt tuyến tiền liệt tận gốc đã được thực hiện qua mổ mở (từ 1998), nội soi ổ bụng tiêu chuẩn (LRP) (từ 2004) [2]. Từ tháng 11/2016, phẫu thuật nội soi có robot hỗ trợ đã được áp dụng tại bệnh viện. Câu hỏi nghiên cứu: đâu là những thuận lợi / khó khăn cho bác sĩ phẫu thuật / bệnh nhân khi mổ nội soi có robot hỗ trợ so với nội soi ổ bụng (NSOB) trong điều kiện Việt Nam ?- Mục tiêu: Đánh giá hiệu quả, độ an toàn của NSOB có robot hỗ trợ trong điều trị phẫu thuật triệt căn ung thư tuyến tiền liệt (UT TTL) khi so sánh với NSOB tiêu chuẩn.- Đối tượng & Phương pháp nghiên cứu: Người bệnh nhập bệnh viện Bình Dân với chẩn đoán UT TTL giai đoạn khu trú (cT1-T2) hoặc xâm lấn vỏ bao hoặc túi tinh (cT3), được cắt tuyến tiền liệt tận gốc bằng nội soi có robot hỗ trợ (RARP)hay bằng NSOB tiêu chuẩn. Nghiên cứu so sánh tiến cứu không ngẫu nhiên so sánh kết quả ngắn hạn (dưới 1 năm) giữa RARP và LRP với thời gian lấy mẫu là từ 01/2019 đến 12/2020.- Kết quả: Có 40 bệnh nhân ở mỗi nhóm phẫu thuật. Đặc điểm bệnh nhân trước mổ hai nhóm không khác biệt về: tuổi, bệnh kết hợp, điểm số ASA, điểm số Gleason, PSA máu, cTNM
hai nhóm có khác biệt về: điểm số IIEF-5 (RARP>
LRP), BMI (RARP>
LRP), Kích thước tuyến tiền liệt (RARP>
LRP). Các biến số quanh phẫu thuật: hai nhóm không khác biệt về: chuyển mổ mở, tỉ lệ thực hiện kỹ thuật bảo tồn cổ bàng quang, lượng máu mất, truyền máu quanh phẫu thuật, tai biến trong mổ
hai nhóm có khác biệt về: tỉ lệ mũi khâu Rocco (RARP>
LRP), số trường hợp nạo hạch chậu (RARP >
LRP), thời gian mổ (RARP LRP), số trường hợp bảo tồn bó mạch - thần kinh cương (RARP LRP), chất lượng cuộc sống 6 tháng sau mổ (nhóm RARP tốt hơn).- Kết luận: RARP so sánh với LRP là kỹ thuật mổ an toàn với ít biến chứng hơn, triệt căn hơn với việc cắt bỏ được nhiều hạch chậu hơn, hiệu quả hơn với thời gian mổ ngắn hơn, ít mất máu hơn, thời gian dẫn lưu ngắn hơn, ít đau hơn, chức năng cơ quan bảo tồn tốt hơn về kiểm soát nước tiểu sau mổ. Nó có đường cong học tập ngắn hơn và có chất lượng cuộc sống sau mổ tốt hơn cho bệnh nhân . Abstract- Introduction: At Binh Dan hospital, radical prostatectomy (RP) was performed by open surgery (since 1998) [1] and by standard laparoscopy (LRP) (since 2004) [2]. Since November 2016, robotics was implemented at our institution. The research question is: what are the advantages / disadvantages for surgeons / patients of robot - assisted radical prostatectomy (RARP) versus laparoscopic radical prostatectomy (LRP) ?- Objectives: To asssess the efficiency, safety of RARP in comparison to LRP and to recognize the patient group suffering from prostate cancer who are suitable for RARP. - Materials and Methods: The patients admitted to Binh Dan hospital with a diagnosis of localized prostate cancer (cT1-T2) or with invasion of capsule and / or seminal vesicles (cT3) underwent RARP or LRP. Non - randomized prospective comparative study comparing short - erm outcomes (less than 1 year) between RARP vs LRP with sampling from Jan 2019 to Dec 2020.- Results: There were 40 patients in each group. Patient characteristics before surgery in the two groups did not differ in: age, comorbidities, ASA score, Gleason score, serum PSA, cTNM
The two groups have differences in: the IIEF-5 score (RARP>
LRP), BMI (RARP>
LRP), Prostate size (RARP>
LRP). Perioperative variables: the two groups did not differ in terms of: conversion rate, rate of bladder neck conservation, blood loss, perioperative blood transfusion, intraoperative complications
The two groups had differences in: rate of Rocco stitches (RARP>
LRP), number of cases of pelvic lymph node dissection (RARP>
LRP), operating time (RARP LRP), the number of cases with neurovascular bundle preservation (RARP LRP), the patients’ quality of life at 6 months postoperatively (RARP group was better).- Conclusions: RARP versus LRP, is a safer procedure with less complications, more radical treatment with more dissectedlymph nodes, more effective with shorter operative time, with trend of less blood loss, shorter drainage time, less pain, better functional outcomes in terms of urinary continence, shorter learning curves and better quality of lifeafter surgery for patients. Two points to be improved are: surgical margins and nerve sparing technique. DOI: 10.59715/pntjmp.1.1.13

1. Đọc trực tuyến

1. Đọc trực tuyến

Tạo bộ sưu tập với mã QR