| 摘要: |
| 目的 分析达芬奇机器人辅助腹腔镜肾部分切除术治疗PADUA评分≥10分肾肿瘤的安全性，可行性，评价手术疗效，探讨临床应用价值。方法 通过分析2012年5月至2013年9月本单位同一术者完成的37例机器人辅助腹腔镜肾部分切除术治疗PADUA评分≥10分肾脏肿瘤患者资料，总结临床经验，评价手术疗效。本组患者男性21例，女性16例，年龄平均52.3±10.1(32-72)岁， BMI平均24.9±3.88(17.1-34.3) kg/m2，Charlson全身合并症评分(Age-weighted)平均0.5±0.84(0-3)，肿瘤侧别(左/右) 20/17，均为单侧单发肿瘤，最大径平均4.2±1.19(2.1-7.2) cm，肾肿瘤PADUA评分平均10.8±0.87(10-13)，术前eGFR ( estimated Glomerular Filtration Rate)平均101.2±25.58(46.6-198.7) mL/min•1.73m2。腔镜下分离肾动静脉、肾周及肿瘤后，阻断肾蒂或不阻断肾蒂，切除肿瘤，缝合重建。结果 37例手术均顺利完成，无手术中转，无任何术中并发症，无术中输血，手术时间平均241±50.0(120-330) min，术中出血量平均185±169.9(50-1000) ml。肾脏缺血时间平均26.7±9.90(0-50) min。术后住院时间平均11.3±3.38(7-23) d。术后并发症发生率13.5%(5/37)。病理学检查提示：手术切缘均为阴性，透明细胞癌28例，嫌色细胞癌3例，乳头状细胞癌1例，血管平滑肌脂肪瘤等肾脏良性病变5例。术后随访时间平均5.9±4.64(1-12)月，37例患者均成活，均未发现局部复发或远处转移，eGFR平均下降百分比8%，与术前相比差异有统计学意义(Z = -2.883, p = 0.004)。结论 对于高PADUA评分的复杂肾肿瘤，达芬奇机器人辅助腹腔镜肾部分切除术微创效果好、操作精细、安全性高，肾功能损害小，肿瘤控制效果需进一步随访观察。 |
| 关键词: 机器人 保留肾单位手术 评分系统 腹腔镜 |
| DOI：10.3724/SP.J.1008.2014.00800 |
| 投稿时间：2013-10-18修订日期：2013-12-15 |
| 基金项目:上海市卫生系统优秀人才培养计划项目(XBR2011027),上海市科技人才计划项目 |
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| Da Vinci Robot-assisted Laparoscopic Partial Nephrectomy for Renal Tumors with PADUA Score of ≥10 |
| wang linhui |
| () |
| Abstract: |
| Objective To evaluate the safety, feasibility and efficacy of da Vinci robot-assisted laparoscopic partial nephrectomy in the treatment of renal tumors with PADUA score of ≥10, and assess its clinical role. Methods Between May 2012 and September 2013, 37 cases of da Vinci robot-assisted laparoscopic partial nephrectomy for renal tumors with PADUA score of ≥10 were performed a single urologist at our institution. Patient age 52.3±10.1(32-72)years; Body mass index 24.9±3.88(17.1-34.3) kg/m2; Charlson Co-morbidity Index (Age-weighted) 0.5±0.84(0-3); Tumor laterality (L/R) 20/17; all tumors were unilateral and solitary lesions with a mean diameter of 4.2±1.19(2.1-7.2)cm and PADUA score of 10.8±0.87(10-13); Preoperative eGFR (mL/min•1.73m2) 101.2±25.58(46.6-198.7). The renal pedicle, involved kidney, tumor exposure, tumor excision and renorrhaphy were conducted with da Vinci robot-assisted laparoscopic techniques. Results All 37 cases were smoothly finished without any surgical conversion, intraoperative complications or transfusion. Operative time was 241±50.0(120-330) min, estimated blood loss was 185±169.9(50-1000) ml, renal ischemia time was 26.7±9.90(0-50) min. The mean postoperative stay was 11.4±3.44(8-19) days with an overall complication rate of 13.5%(5/37). Pathological examination revealed none of positive surgical margin, 28 cases of renal clear cell carcinoma, 3 papillary cell carcinoma, and 5 different types of benign lesions. At a mean follow-up of 5.9±4.64(1-12) months, all patients are alive and no local recurrence or distant metastasis were detected. Nevertheless, the estimated glomerular filtration rate decreased at a mean percentage of 8 and before-after comparison revealed significant difference(Z=-2.883, p=0.004). Conclusion da Vinci robot-assisted laparoscopic partial nephrectomy provides a meticulous alternative in the surgical management of high PADUA score renal tumors with minimally invasiveness, improved safety, and renal function preservation, although the cancer control outcomes are awaited further follow-up. |
| Key words: Robot Nephron-Sparing Surgery, NSS Scoring system Laparoscopy |
