| 摘要: |
| 目的 评估机器人辅助腹腔镜肾部分切除术（RAPN）治疗特殊肾门部位（肾门偏上极骑跨肾血管及肾门前后唇，HUS）肿瘤的疗效和安全性。方法 回顾性分析2016年2月至2018年12月于我院接受RAPN治疗的患者临床基本资料，筛选出典型HUS部位肾门肿瘤13例（HUS组），并筛选R.E.N.A.L.评分与之相当的13例非HUS部位肾门肿瘤（非HUS组）作为对照。分析并比较两组患者基本资料、围手术期结果、并发症、肾功能变化和肿瘤复发转移情况。结果 两组患者肿瘤最大直径、R.E.N.A.L.评分具有较好的可比性，但HUS组中有3例手术中转开放肾部分切除术。与非HUS组相比，HUS组的手术时间[（132.92±22.33）min vs（110.85±20.97）min]和肾脏热缺血时间[（28.08±6.29）min vs（22.15±5.87）min]均较长，差异均有统计学意义（P均<0.05）。两组患者的术中出血量、输血率、术后住院时间、术后短期肾功能变化、切缘阳性率、并发症发生率、"三连胜"（trifecta）达标率差异均无统计学意义（P均>0.05）。随访期间两组患者均无复发转移、无死亡。结论 HUS部位肾门肿瘤行RAPN需要更长的手术时间和肾脏阻断时间，并且术中更改手术方式的概率也较大，需要根据肿瘤特征和术者经验合理选择手术方式。 |
| 关键词: 肾肿瘤 肾门肿瘤 机器人手术 腹腔镜技术 肾部分切除术 |
| DOI：10.16781/j.0258-879x.2020.07.0714 |
| 投稿时间：2019-08-07修订日期：2020-02-21 |
| 基金项目: |
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| Robot-assisted laparoscopic partial nephrectomy for hilar tumors close to upper pole of kidney and straddling renal pedicle |
| GUAN Wei,ZHANG Zong-biao,YANG Jun,LU Yu-chao,LIU Zheng,WANG Shao-gang* |
(Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
*Corresponding author) |
| Abstract: |
| Objective To evaluate the efficacy and safety of robot-assisted laparoscopic partial nephrectomy (RAPN) for specific renal hilar tumors (hilar tumors close to the upper pole of kidney and straddling renal pedicle, HUS renal tumors). Methods The clinical data of patients who received RAPN from Feb. 2016 to Dec. 2018 in our hospital were retrospectively analyzed. A total of 13 cases with typical HUS renal tumors were selected, and 13 cases with non-HUS hilar tumors with similar R.E.N.A.L. score were selected as controls. The demographic data, perioperative results, complications, renal function changes and oncologic outcomes of the two groups were analyzed and compared. Results The maximal tumor size and R.E.N.A.L. score were comparable between the two groups. RAPN of three patients with HUS renal tumors were converted to open partial nephrectomy. The operation time ([132.92±22.33] min vs [110.85±20.97] min) and warm ischemia time ([28.08±6.29] min vs [22.15±5.87] min) were significantly longer in the HUS group compared with those in the non-HUS group (P<0.05). There were no significant differences in the estimated blood loss, transfusion rate, length of hospital stay, postoperative short-term renal function change, positive margin rate, complications, or trifecta rate between the two groups (all P>0.05). No recurrence, metastasis or death occurred in the two groups during the follow-up. Conclusion RAPN for HUS renal tumor requires longer operation time and warm ischemia time, and has higher conversion rate from RAPN to open surgery, so it is necessary to select surgery strategy according to tumor characteristics and operator's experience. |
| Key words: kidney neoplasms hilar tumor robotic surgical procedures laparoscopy partial nephrectomy |
