Kỹ thuật bảo tồn thần kinh cương trong phẫu thuật nội soi cắt tuyến tiền liệt tận gốc có hỗ trợ Robot: Kết quả ban đầu qua 14 trường hợp

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Tác giả: Viết Nhật Tân Mai, Phúc Cẩm Hoàng Nguyễn, Tế Kha Nguyễn, Đỗ Hữu Toàn Trần, Võ Anh Vinh Trang

Ngôn ngữ: vie

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Thông tin xuất bản: Tạp chí Y Dược học Phạm Ngọc Thạch, 2024

Mô tả vật lý: tr.104

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ID: 361540

Thêm vào giỏ Liên kết toàn văn

- Mục Tiêu: Báo cáo những kinh nghiệm đầu tiên về kỹ thuật bảo tồn thần kinh cương trong phẫu thuật cắt tuyến tiền liệt tận gốc có hỗ trợ robot ngả trong phúc mạc qua 14 trường hợp. - Đối tượng và phương pháp nghiên cứu: Mười bốn bệnh nhân (BN) được thực hiện kỹ thuật bảo tồn thần kinh cương trong phẫu thuật cắt tuyến tiền liệt tận gốc có hỗ trợ robot ngả trong phúc mạc phúc mạc tại bệnh viện Bình Dân từ 12/2019 đến 01/2021. Hệ thống robot phẫu thuật daVinci® Si được sử dụng. Bệnh nhân nằm tư thế Trendelenburg nghiêng 10 - 150. Tất cả bệnh nhân mổ đều được bảo tồn thần kinh cương theo kỹ thuật của Vipul Patel (ngả sau, xuôi chiều). Các biến số ghi nhận gồm: tuổi, chỉ số khối cơ thể (BMI), kích thước tuyến tiền liệt, kháng nguyên đặc hiệu tuyến tiền liệt (PSA) trước và sau mổ, điểm số Gleason, thời gian mổ, điểm IIEF đánh giá tình trạng cương trước và sau mổ, khả năng kiểm soát nước tiểu sau mổ, kết quả giải phẫu bệnh sau mổ. - Kết quả: Mẫu nghiên cứu gồm có 14 trường hợp với tuổi trung bình: 64,21 ± 6,68. Thể tích tuyến tiền liệt: 48,2 mL, PSA trung bình: 30,5 ng/mL. Thời gian mổ: 225 ± 41,1 phút (150 - 300), Lượng máu mất: 278,6 ± 97,5 mL (100 - 500), Số ngày nằm viện sau mổ: 5,9 ± 1,4 ngày (3 - 8). Biên phẫu thuật dương tính: 3/14 (21,4%). Tỉ lệ cương sau mổ tại thời điểm 6 tháng là 42,8% (6/14) tỉ lệ kiểm soát nước tiểu (không sử dụng tã) tại thời điểm 6 tháng là 78,6% (11/14BN). Ở nhóm bảo tồn thần kinh cương 2 bên khả năng kiểm soát nước tiểu tốt hơn nhóm chỉ bảo tồn 1 bên. Tất cả bệnh nhân bảo tồn thần kinh cương 1 bên đều không còn khả năng cương sau mổ. - Kết luận: Kỹ thuật bảo tồn thần kinh cương trong phẫu thuật cắt tuyến tiền liệt tận gốc có hỗ trợ robot là phương pháp tiếp cận xâm lấn tối thiểu, an toàn và hiệu quả cho bệnh nhân ung thư tuyến tiền liệt nhằm bảo tồn tối đa chức năng cơ quan sau mổ. Cần thực hiện thêm nhiều trường hợp hơn nữa với thời gian theo dõi lâu hơn để đánh giá đầy đủ chức năng cương và kiểm soát nước tiểu của bệnh nhân sau mổ. Abstract- Objectives: To report our perioperative outcomes of nerve - sparing technique inrobot ‑ assisted radical prostatectomy (RARP) in initial 14 cases. - Materials and Methods: Fourteen patients underwent robot ‑ assisted radical prostatectomy at Binh Dan hospital from December 2019 to January 2021. The surgical robot system daVinci® Si was used. Patients were placed in 10 ‑ 150 Trendelenburg position. All patients were performed nerve sparing technique according to Vipul Patel (posterior approach). Collected data included patient age, body mass index (BMI), prostate volume, prostate specific antigen (PSA) levels, preoperative biopsy and postoperative Gleason score, operative time, estimated blood loss, complications, erectile function (before and after operation) based on IIEF - 5 questionnaire, urinary continence, postoperative pathology. - Results: Sample size was 14 patients. Mean patient age: 64.21 ± 6.68 years. Prostate volume: 48,2 mL, mean PSA levels: 30.5 ng/mL. Operative time: 225 ± 41.1 minutes (150 - 300), Estimated blood loss: 278.6 ± 97.5 mL (100 - 500), Postoperative hospital stay: 5.9 ± 1.4 days (3 - 8). Positive surgical margin: 3/14 (21.4%). No complications were detected. Urinary continence rate (no pads) at 6 months after operation is 78.6% (11/14cases). Erectile rate is 42.8% (6/14 cases). Urinary continence recovered better in bitalteral nerve sparing group compared with unilateral nerve sparing group. There is no erection in unilateral nerve sparing group. - Conclusions: Nerve sparing technique in RARP is an efficacious, minimally invasive approach for patients with localized carcinoma of the prostate. It is essential to increase the number of patients and follow up time for adequate evaluation of posroperative urinary continence and erectile function. DOI: 10.59715/pntjmp.2.4.9

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