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傾向性評分隊列研究兩種不同入路機器人輔助根治性前列腺切除術(shù)的臨床效果

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Propensity score-matched comparison of the clinical efficacy between two approaches of robot-assisted radical prostatectomy

LI Zhenhao， ZHU Zhaowei， ZHAO Pin， TAO Jin， LI Peng， FAN Yafeng， LIU Yunlong， YU Shuanbao， ZHANG Xuepei

（Department of Urology， The First Affiliated Hospital of Zhengzhou University， Zhengzhou 450052， China）

ABSTRACT：Objective To compare the clinical efficacy and postoperative urinary control between robot-assisted radical prostatectomy （RARP） with posterior-anterior-lateral （PAL） approach and with anterior （conventional） approach using propensity score matching method.Methods Clinical data of 145 patients undergoing RARP in our hospital during Jan.2020 and Jan.2023 were retrospectively analyzed， including 122 patients in the conventional group and 23 in the PAL group.The patients were matched by 2∶1 propensity score matching， including 46 cases in the conventional group and 23 in the PAL group.The perioperative outcomes were compared of prostate cancer （PCa） patients undergoing RARP surgery with different approaches before and after matching， including operation time， intraoperative blood loss， pelvic drainage time， hospitalization days， preservation of neurovascular bundles （NVB） during surgery， deep dorsal venous complex （DVC） suture， reconstruction of bladder neck， and postoperative urinary control recovery rate after extubation immediately， and 1， 3， and 6 months after surgery.Results There were no significant differences in baseline data， operation time， bleeding volume， pelvic drainage time， hospitalization days， preservation of NVB， and reconstruction of bladder neck between the two groups （P>0.05）.The PAL group used less DVC suture during surgery （30.4% vs. 100%， P<0.001）， but had better urinary control recovery rate immediately after extubation， 1， 3 and 6 months after surgery （P<0.05）.Conclusion RARP with PAL approach is as safe and effective as the conventional approach， and has significant advantages in early postoperative urinary control.

KEY WORDS：robot-assisted；prostate cancer；radical prostatectomy；posterior-anterior-lateral；robot-assisted radical prostatectomy；early urinary control；propensity score matching

摘要：目的 通過傾向性評分匹配法對比后入路-前入路-側(cè)入路（PAL）聯(lián)合入路與前入路（常規(guī)入路）機器人輔助根治性前列腺切除術(shù)（RARP）治療前列腺癌（PCa）的臨床效果及對術(shù)后尿控的影響。（剩余9580字）

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