目的

探讨前列腺术前MRI参数及临床因素对机器人前列腺癌根治术后腹股沟疝（PIH）的预测价值。

方法

采用回顾性病例对照研究分析2020年1月至2024年8月在安徽医科大学第一附属医院泌尿外科接受机器人辅助根治性前列腺切除术（RARP）的469例患者的临床资料、术前前列腺MRI和术后病理报告。根据术后疝外科医师随访诊断结果分为病例组（有PIH）和对照组（无PIH），采用Kaplan-Meier绘制RARP术后无PIH生存曲线，logistic回归分析PIH的危险因素。

结果

最终纳入438例RARP患者，中位随访时间（19.3±8.6）个月，共50例（11.4%）发生PIH。2组患者在年龄、吸烟史、饮酒史、术前前列腺特异性抗原、术前Gleason评分、术中盆腔淋巴结清扫、手术时间和术后病理N分期方面差异无统计学意义。2组患者的体重指数和术后病理的T分期差异有统计学意义（P＜0.05）。体重指数＜18.5 kg/m²和体重指数≥25.0 kg/m²术后2年无PIH生存率分别为76.50%和92.22%，差异有统计学意义（P=0.029）。≤T2和≥T3术后2年无PIH生存率分别为91.01%和80.64%，差异有统计学意义（P=0.037）。前列腺MRI参数中，矢状位T2加权图像上测量的最大纵向长度（Sag-H）差异有统计学意义（t=2.555，P=0.011）。多因素logistic分析结果显示，术后病理的T分期（≥T3）和矢状位T2加权图像上测量的前列腺Sag-H（＞5.46 cm）是PIH发生的独立危险因素（P＜0.05），调整后OR值为1.847（95% CI 1.017～3.356）和1.419（95%CI 1.033～1.949）。

结论

低体重指数、高T分期（≥T3）和前列腺Sag-H（＞5.46 cm）是机器人前列腺癌根治术后PIH发生的危险因素，未来仍需要多中心前瞻性研究以进一步验证。

Objective

To explore the predictive value of preoperative MRI parameters of the prostate and clinical factors for inguinal hernia （PIH） after robot-assisted radical prostatectomy （RARP）.

Methods

A retrospective case-control study was conducted to analyze the clinical data， preoperative prostate MRI and postoperative pathological reports of 469 patients who underwent RARP in the Department of Urology， the First Affiliated Hospital of Anhui Medical University from January 2020 to August 2024. According to the follow-up diagnosis results of hernia surgeons after surgery， they were divided into the case group （PIH group） and the control group （non-PIH group）. Kaplan-Meier plotted the PIH free survival curve after RARP and logistic regression analysis was used to analyze the risk factors of PIH.

Results

A total of 438 patients with RARP were included in this study. The median follow-up time was （19.3±8.6） months， and a total of 50 patients （11.4%） developed PIH. There were no statistically significant differences between the two groups in age， smoking history， alcohol consumption history， level of preoperative prostate-specific antigen， preoperative Gleason score， intraoperative pelvic lymph node dissection， duration of operation， and pathological N stage. Body mass index （BMI） and T stage of postoperative pathology were significantly different between the two groups （P＜0.05）. The 2-year PIH-free survival rates of BMI＜18.5 kg / m² and BMI≥25.0 kg / m² were 76.50 % and 92.22 %， respectively， and the difference was statistically significant （P=0.029）. The 2-year PIH-free survival rates of≤T2 and≥T3 were 91.01 % and 80.64 %， respectively， and the difference was statistically significant （P=0.037）. In prostate MRI parameters， Sag-H measured on sagittal T2-weighted images had significant differences （t=2.555， P=0.011）.Multivariate logistic analysis showed that T stage of postoperative pathology （≥T3） and Sag-H （＞5.46 cm）measured on sagittal T2-weighted images were independent risk factors for PIH （P＜0.05）. Adjusted OR values were 1.847 （95% CI 1.017-3.356） and 1.419 （95% CI 1.033-1.949）.

Conclusion

Low BMI， high T stage （≥T3） and Sag-H （＞5.46 cm） are risk factors for PIH after RARP. The results still require multi-center prospective studies for further verification in the future.