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目的:探讨机器人辅助腹腔镜根治性前列腺切除术(RARP)后切缘阳性的影响因素。方法:回顾性分析2014年10月至2019年1月于郑州大学第一附属医院由单一术者行RARP的310例患者的临床资料。中位年龄68(62～72)岁，PSA中位值26(13～63)ng/ml，f/tPSA中位值0.12(0.07～0.18)，PSAD中位值0.36(0.20～0.75) ng/mln 2。临床分期Tn 1期115例，Tn 2期100例，Tn 3期41例，Tn 4期15例。MRI或超声检查测量前列腺左右径中位值44(35～50)mm、前后径中位值45(40～51)mm、上下径中位值41(36～50)mm，前列腺体积中位值76(54～118)ml。226例术前行经直肠超声引导系统性12针穿刺，对超声检查异常区域再行1～5针穿刺。穿刺总针数中位值12(12～13)针，阳性针数中位值9(4～12)针，阳性针数百分比中位值85%(35%～100%)。术前病理确诊方式分别为电切手术84例(27%)和前列腺穿刺活检226例(73%)。术前240例获得Gleason评分，其中≤6分61例，7分95例，≥8分84例。237例(76%)行新辅助内分泌治疗。根据术后病理结果将患者分为切缘阳性组和切缘阴性组，分析一般临床资料、PSA衍生指标、前列腺大小、穿刺阳性针数百分比、活检Gleason评分、病理确诊方式和内分泌治疗与切缘阳性的相关性。n 结果:本组310例，术后病理检查106例切缘阳性，切缘阳性率为34.2%。单因素分析结果显示(切缘阳性组与切缘阴性组比较)，tPSA(41.3 ng/ml与24.8 ng/ml，n P＝0.029)、f/tPSA(0.14与0.10，n P＝0.004)、前列腺左右径(46 mm与38 mm，n P＝0.049)、穿刺阳性针数百分比(100%与58%，n P＝0.001)、活检Gleason评分(≤6分、7分、≥8分：14、31、42例与47、64、42例，n P0.05)。多因素分析结果显示，前列腺左右径(n OR＝1.08，95%n CI 1.01～1.15，n P＝0.026)和穿刺阳性针数百分比(n OR＝6.00，95%n CI1.03～38.74，n P＝0.048)是切缘阳性的独立危险因素。n 结论:前列腺左右径和穿刺阳性针数百分比是RARP术后切缘阳性的独立危险因素。“,”Objective:To analyze the correlation between preoperative parametres and positive surgical margin after robot-assisted laparoscopic radical prostatectomy.Method:From October 2014 to January 2019, the clinical data of 310 patients who underwent robot-assisted laparoscopic radical prostatectomy(RARP) by single surgeon were collected retrospectively. The median age, PSA, f/t PSA and PSAD was 68(62-72)years, 26(13-63) ng/ ml, 0.12 (0.07-0.18) and 0.36(0.20-0.75) ng/mln 2, respectively. There were 115 cases with clinical Tn 1, 100 with clinical Tn 2, 41 with clinical Tn 3, and 15 with clinical Tn 4. Based on the MRI or ultrasound examination, the median value for the transverse diameter, anteroposterior diameter, vertical diameter, and volume of the prostate is 44(35-50)mm, 45(40-51)mm, 41(36-50)mm, and 76(54-118)ml, respectively. In this study, 84(27%)cases were diagnosed pathologically by transurethral resection of the prostate, and 226(73%)cases by prostate biopsy. The biopsy technique was transrectal ultrasound-guided systematic 12-point biopsy, and additional 1-5 needles were performed in regions with abnormal ultrasound echoes. The median for total number of puncture needles, number and percentages of positive needles were 12(12-13), 9(4-12)and 85%(35%-100%), respectively. Of all the patients, there were 61 cases with Gleason score≤6, 95 with Gleason score=7 and 84 with Gleason score≥8. There were 237(76%)patients undergoing neoadjuvant endocrine therapy. The patients were divided into the negative surgical margin group and positive surgical margin group. The correlation between positive surgical margin and general clinical data, PSA derivates, prostate size (transversal diameter, anteroposterior diameter, vertical diameter, and prostate volume), percentage of positive biopsy cores, Gleason score, method of pathological diagnosis, and endocrine therapy were analyzed.n Results:Of all the 310 enrolled patients, the overall positive surgical margin rate was 34.2%(106/310). Univariate analysis showed that tPSA(41.3 ng/ml vs.24.8ng/ml, n P=0.029), f/tPSA(0.14 vs.0.10, n P=0.004), transversal diameter of prostate(46 mm vs.38mm, n P=0.049), percentage of positive biopsy cores(100% vs.58%, n P=0.001), and biopsy Gleason score(Gleason score≤6, =7 and ≥8: 14, 31 and 32 cases vs. 47, 64 and 42 cases, n P<0.05)exhibited significant correlation with postoperative positive surgical margin. Multivariate analysis showed that transversal diameter of prostate(n P=0.026) and percentage of positive biopsy cores(n P=0.048) were independent risk factors for positive surgical margin.n Conclusions:Transversal diameter of prostate and percentage of positive biopsy cores were independent risk factors, which help to predict the occurrence of postoperative positive surgical margin.