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| 机器人辅助与传统腹腔镜肾部分切除术治疗早期肾癌合并肥胖患者的疗效对比 |
| 富智斌1△,陈如潭2△,顾迪1,董凯1,江爱民1,晏睿1,时佳子1,吴震杰1,王林辉1* |
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(1. 海军军医大学(第二军医大学)长征医院泌尿外科, 上海 200003;
2. 海军军医大学(第二军医大学)长征医院影像医学与核医学科, 上海 200003
△共同第一作者
*通信作者) |
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| 摘要: |
| 目的 比较机器人辅助腹腔镜肾部分切除术（RAPN）与传统腹腔镜肾部分切除术（LPN）治疗早期肾癌合并肥胖患者的临床疗效。方法 回顾性分析2016年1月至2018年8月我院收治的71例行RAPN或LPN治疗的早期肾癌（cT1N0M0）合并肥胖（BMI ≥ 28 kg/m2）患者的临床资料。RAPN组34例，男22例、女12例，年龄为（51.2±13.4）岁，BMI为（30.36±2.21）kg/m2，肿瘤最大径为（3.67±1.09）cm，R.E.N.A.L.评分为（7.3±1.7）分，术前估算的肾小球滤过率（eGFR）为（92.8±22.0）mL/（min·1.73 m2），手术采用经腹腔途径7例、经后腹腔途径27例；LPN组37例，男26例、女11例，年龄为（56.2±12.6）岁，BMI为（29.74±1.36）kg/m2，肿瘤最大径为（3.37±0.93）cm，R.E.N.A.L.评分为（6.9±1.6）分，术前eGFR为（90.4±22.4）mL/（min·1.73 m2），手术采用经腹腔途径6例、经后腹腔途径31例。记录两组患者手术时间、术中出血量、术中输血率、肾脏热缺血时间、手术中转率、术中及术后并发症发生率、切缘阳性率、术后住院时间、术后肾功能下降百分比等指标并进行比较。结果 两组患者手术均顺利完成，均未发生术中并发症，无术中转开放手术或根治性肾切除术。RAPN组肾脏热缺血时间[（19.2±5.6）min]短于LPN组[（21.8±4.1）min]，术后住院时间[（6.0±1.2）d]短于LPN组[（7.4±2.8）d]，差异均有统计学意义（P均<0.05）。RAPN组与LPN组的手术时间分别为（153.0±33.3）min和（140.1±32.3）min，术中出血量分别为（88.5±49.1）mL和（106.2±72.0）mL，术中输血率分别为2.9%（1/34）和5.4%（2/37），术后并发症发生率分别为0和8.1%（3/37），术后肾功能下降百分比分别为2.1%（-4.8%，9.3%）和5.8%（1.5%，15.7%），差异均无统计学意义（P均>0.05）。术后病理结果显示所有患者手术切缘均为阴性。结论 RAPN和LPN均为治疗早期肾癌合并肥胖患者的有效术式。与LPN相比，RAPN治疗早期肾癌合并肥胖患者能减少术中肾脏热缺血时间，缩短术后住院时间，更利于保护患者肾功能，加快术后恢复。 |
| 关键词: 肥胖症 肾肿瘤 机器人手术 腹腔镜技术 肾部分切除术 |
| DOI：10.16781/j.0258-879x.2020.07.0704 |
| 投稿时间：2019-11-04修订日期：2020-02-16 |
| 基金项目: |
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| Robot-assisted and traditional laparoscopic partial nephrectomy in the treatment of obese patients with early renal tumors: a comparison of clinical efficacy |
| FU Zhi-bin1△,CHEN Ru-tan2△,GU Di1,DONG Kai1,JIANG Ai-min1,YAN Rui1,SHI Jia-zi1,WU Zhen-jie1,WANG Lin-hui1* |
(1. Department of Urology, Changzheng Hospital, Naval Medical University(Second Military Medical University), Shanghai 200003, China;
2. Department of Medical Imaging and Nuclear Medicine, Changzheng Hospital, Naval Medical University(Second Military Medical University), Shanghai 200003, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To compare the clinical efficacy of robot-assisted partial nephrectomy (RAPN) and traditional laparoscopic partial nephrectomy (LPN) in the treatment of obese patients with early renal tumors. Methods The clinical data of 71 obese patients (body mass index [BMI] ≥ 28 kg/m2) with cT1N0M0 renal tumors, who receiving RAPN or LPN in our hospital between Jan. 2016 and Aug. 2018, were retrospectively collected. There were 22 males and 12 females in RAPN group (n=34), with a mean age of (51.2±13.4) years and a mean BMI of (30.36±2.21) kg/m2. The mean tumor size, R.E.N.A.L. score and preoperative estimated glomerular filtration rate (eGFR) were (3.67±1.09) cm, 7.3±1.7 and (92.8±22.0) mL/(min·1.73 m2), respectively. The operation was performed by transperitoneal approach in seven cases and retroperitoneal approach in 27 cases. There were 26 males and 11 females in LPN group (n=37), with a mean age of (56.2±12.6) years and a mean BMI of (29.74±1.36) kg/m2. The mean tumor size, R.E.N.A.L. score and preoperative eGFR were (3.37±0.93) cm, 6.9±1.6 and (90.4±22.4) mL/(min·1.73 m2), respectively. The operation was performed by transperitoneal approach in six cases and retroperitoneal approach in 31 cases. The operation time, estimated blood loss, intraoperative blood transfusion rate, warm ischemia time, intraoperative conversion rate, incidence of intra-and postoperative complications, positive surgical margin, postoperative hospital stay, and variation of eGFR from baseline were recorded and compared between the two groups. Results The partial nephrectomy operation was successfully completed in both groups with no intraoperative complications, and there was no intraoperative conversion to open surgery or radical nephrectomy. There were significant differences in warm ischemia time ([19.2±5.6] min vs [21.8±4.1] min) and postoperative hospital stay ([6.0±1.2] d vs [7.4±2.8] d) between the RAPN group and LPN group (both P<0.05). No significant differences were found in operation time ([153.0±33.3] min vs [140.1±32.3] min), estimated blood loss ([88.5±49.1] mL vs [106.2±72.0] mL), intraoperative blood transfusion rate (2.9% [1/34] vs 5.4% [2/37]), incidence of postoperative complications (0 vs 8.1% [3/37]) or variation of eGFR from baseline (2.1% [-4.8%, 9.3%] vs 5.8% [1.5%, 15.7%]) between the two groups (all P>0.05). Post-operation pathology results showed no positive surgical margin in the two groups. Conclusion Both RAPN and LPN are effective for the treatment of obese patients with early renal tumors. Compared with LPN, RAPN can reduce the warm ischemia time, shorten postoperative hospital stay, better protect renal function and accelerate postoperative recovery. |
| Key words: obesity kidney neoplasms robotic surgical procedures laparoscopy partial nephrectomy |
