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| 机器人辅助腹腔镜下肾部分切除术(附230例报告) |
| 汪洋1,吕晨1,吴震杰2,盛佳雁1,程超3,左长京3,王林辉2,孙颖浩1,叶华茂1* |
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| (第二军医大学长海医院泌尿外科, 上海 200433;第二军医大学长征医院泌尿外科, 上海 200003;第二军医大学长海医院核医学科, 上海 200433) |
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| 摘要: |
| 目的 总结机器人辅助腹腔镜肾部分切除术（robotic-assisted partial nephrectomy，RAPN）的手术经验，探讨该术式的疗效及安全性。方法 回顾分析第二军医大学长海医院2012年3月至2015年6月实施RAPN的230例患者的临床资料，其中男性161例、女性69例，年龄19~78岁，平均年龄（51.1±12.1）岁。左侧111例，右侧118例，双侧1例。肾门部肿瘤13例，完全内生性肿瘤8例，大肿瘤（直径>4 cm）54例；孤立性肾肿瘤3例。术前肾小球滤过率（GFR）均正常。肾脏CTA检查提示肾动脉单支211例，2支16例，3支3例。结果 本组手术均成功完成。经腹腔入路198例，其中中线布局191例，旁侧布局6例，混合布局1例；腹膜后入路32例。手术时间平均（196±59）min。2例患者术中出血量≥1 000 mL，其余患者术中失血量平均（148.3±126.5）mL。术中输血3例，中转开放手术1例。热缺血时间平均（20.7±9.1）min，术后住院天数平均（8.9±3.3）d。术后出现严重肉眼血尿3例，其中1例行保守治疗、2例行数字减影血管造影（DSA）肾动脉分支栓塞术后痊愈；术后出现尿漏1例，经充分引流痊愈；术后发生脑栓塞1例。术后病理：恶性肿瘤195例，其中肾透明细胞癌179例、嫌色细胞癌11例、乳头状肾细胞癌5例，分期T1N0M0 154例、T2aN0M0 41例；血管平滑肌脂肪瘤等良性病变35例。肿瘤直径为1.3~9.0 cm，平均（3.41±1.57）cm，肿瘤切缘均阴性。结论 RAPN是一种安全、有效的治疗局限性肾脏肿瘤的手术术式，该术式在肾脏肿瘤的完整切除及肾脏创面的缝合上有明显优势。 |
| 关键词: 肾肿瘤 机器人 腹腔镜检查 肾部分切除术 |
| DOI：10.16781/j.0258-879x.2016.09.1159 |
| 投稿时间：2015-10-18修订日期：2016-04-21 |
| 基金项目:国家自然科学基金面上项目（81272818）. |
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| Experience of robot-assisted partial nephrectomy: a report of 230 cases |
| WANG Yang1,LÜ Chen1,WU Zhen-jie2,SHENG Jia-yan1,CHENG Chao3,ZUO Chang-jing3,WANG Lin-hui2,SUN Ying-hao1,YE Hua-mao1* |
| (Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China;Department of Urology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China;Department of Nuclear Medicine, Changhai Hospital, Second Military Medical University, Shanghai 200433, China) |
| Abstract: |
| Objective To investigate the efficacy and safety of robot-assisted partial nephrectomy (RAPN) by summarizing the surgical experience Methods The clinical data of 230 patients who underwent RAPN in Changhai Hospital from March 2012 to June 2015 were analyzed. The patients included 161 males and 69 females, with an average age of (51.1±12.1) years old. There were 111 tumors in the left kidney and 118 in the right, with 1 case having tumors in bilateral kidneys. There were 13 hilar tumors and 8 endophytic tumors. There were 54 large tumors (>4 cm in diameter) and 3 tumors in solitary kidney. Preoperative glomerular filtration rate (GFR) test was normal in all cases. Kidney CTA scan showed single branch of the renal artery in 211 cases, two branches in 16 cases, and three branches in 3 cases. Results The surgery was successfully completed in all the 230 cases. A total of 198 cases were via transperitoneal approach, including 191 cases with medial camera port placement, 6 with lateral camera port placement and 1 with mix port placement; and 32 cases were via retroperitoneal approach. The mean surgery duration was (196±59) min and the mean blood loss was (148.3±126.5) mL, despite 2 cases having a blood loss of more than 1 000 mL. There were 3 intraoperative blood transfusion cases and one conversion to open surgery. The mean warm ischemia time was (20.7±9.1) min. The mean postoperative hospital stay was (8.9±3.3) days. Serious gross hematuria occurred in 3 patients after the surgery, which was relieved by conservative treatment in one patient and DSA super-selective bleeding artery embolization in 2 patients. Urinary leakage occurred in one case and was cured by complete drainage. Cerebral embolism occurred in one case. Postoperative pathology reported malignant tumor in 195 cases, including renal clear cell carcinoma in 179 cases, chromophobe cell carcinoma in 11 cases and papillary renal cell carcinoma in 5 cases. T1N0M0 tumor was found in 154 cases and T2aN0M0 tumor was found in 41 cases; angiomyolipoma and other benign tumors were found in 35 cases. The maximum diameter of the tumor ranged from 1.3 to 9.0 cm, averaging (3.41±1.57) cm. There were no positive surgery margins in our cohort. Conclusion RAPN is a safe and effective surgery for local renal tumors, and it has significant advantages in complete resection of the renal tumors and the reconstruction of the kidney. |
| Key words: kidney neoplasms robotics laparoscopy partial nephrectomy |
