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| 国产单孔蛇形臂机器人手术系统在经后腹腔肾肿瘤肾部分切除术和肾上腺肿瘤切除术中的初步应用 |
| 朱清毅1,张超2,魏勇1,王正2,肖成武2,沈露明1,杨健1,周铁2,杨波2,王林辉2* |
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(1. 南京医科大学第二附属医院泌尿外科, 南京 210011;
2. 海军军医大学(第二军医大学)第一附属医院泌尿外科, 上海 200433
*通信作者) |
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| 摘要: |
| 目的 探索经后腹腔单孔机器人肾肿瘤肾部分切除术和肾上腺肿瘤切除术的安全性和有效性。方法 2021年11月至2022年2月，海军军医大学（第二军医大学）第一附属医院和南京医科大学第二附属医院采用国产单孔蛇形臂机器人手术系统完成经后腹腔肾肿瘤肾部分切除术和肾上腺肿瘤切除术7例，其中肾上腺肿瘤切除术4例，肾肿瘤肾部分切除术3例。记录所有患者肿瘤最大直径、手术入路、手术时间、术中出血量、切口数量、切口大小、围手术期并发症、病理诊断等资料。记录肾肿瘤肾部分切除术患者术前和出院前血肌酐、热缺血时间和切缘情况。结果 所有手术均采用经后腹腔途径。4例患者接受肾上腺肿瘤切除术，3例肿瘤位于右侧、1例位于左侧，肿瘤最大直径1.2～3.3 cm；4例均为纯单孔手术，切口直径3.0～4.5 cm；手术操作时间50～96 min，术中出血量10～50 mL，围手术期无明显并发症。3例患者接受肾肿瘤肾部分切除术，术前血肌酐分别为77、43、108 μmol/L；3例肿瘤均位于右侧，最大直径1.9～2.7 cm，R.E.N.A.L.评分分别为5P、4X、4P；2例采用纯单孔术式，切口分别为4.5、4.0 cm，1例增加一个12 mm辅助通道；手术操作时间52～150 min，术中出血量10～50 mL，热缺血时间22～30 min；术后病理诊断为肾透明细胞癌2例、切缘均为阴性，血管平滑肌脂肪瘤1例，围手术期未出现出血、漏尿、发热等并发症，出院前血肌酐分别为99、50、93 μmol/L。结论 采用国产单孔蛇形臂机器人手术系统可安全、有效地开展经后腹腔肾肿瘤肾部分切除术和肾上腺肿瘤切除术。 |
| 关键词: 机器人手术 单孔腹腔镜手术 肾上腺肿瘤 肾肿瘤 肾上腺部分切除术 肾部分切除术 蛇形臂 |
| DOI：10.16781/j.CN31-2187/R.20220284 |
| 投稿时间：2022-04-07修订日期：2022-05-10 |
| 基金项目:国家自然科学基金（81730073，82000654）. |
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| Preliminary application of a domestic single-port robotic surgical system in retroperitoneal partial nephrectomy and partial adrenalectomy |
| ZHU Qing-yi1,ZHANG Chao2,WEI Yong1,WANG Zheng2,XIAO Cheng-wu2,SHEN Lu-ming1,YANG Jian1,ZHOU Tie2,YANG Bo2,WANG Lin-hui2* |
(1. Department of Urology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu, China;
2. Department of Urology, The First Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To explore the safety and effectiveness of retroperitoneal robotic single-port partial nephrectomy and partial adrenalectomy. Methods From Nov. 2021 to Feb. 2022, doctors in The First Affiliated Hospital of Naval Medical University (Second Military Medical University) and The Second Affiliated Hospital of Nanjing Medical University completed 7 cases of retroperitoneal partial nephrectomy and partial adrenalectomy with a domestic single-port robotic surgical system, including 4 cases of partial adrenalectomy and 3 cases of partial nephrectomy. The maximal tumor diameter, surgical approach, operation time, estimated blood loss, incision number, incision size, perioperative complications and pathological diagnosis were recorded in all patients. The serum creatinine before operation and discharge, warm ischemia time, and surgical margin were recorded in patients undergoing partial nephrectomy. Results All surgeries were carried out through retroperitoneal approach. Four patients underwent partial adrenalectomy. Three tumors were located on the right side and 1 on the left. The maximal tumor diameter was 1.2-3.3 cm. All 4 cases were pure single-port surgery, and the incision diameter was 3.0-4.5 cm. The operation time was 50-96 min, the amount of intraoperative bleeding was 10-50 mL, and there were no obvious complications during the perioperative period. Three patients underwent partial nephrectomy, and their preoperative serum creatinine were 77, 43, and 108 μmol/L, respectively. All 3 tumors were located on the right side, with a maximal diameter of 1.9-2.7 cm. The R.E.N.A.L. scores were 5P, 4X, and 4P, respectively. Pure single-port operation was applied in 2 cases, the incision was 4.5 and 4.0 cm, respectively. A 12-mm auxiliary trocar was placed in 1 case. The operation time was 52-150 min, the intraoperative bleeding was 10-50 mL, and the warm ischemia time was 22-30 min. There were 2 cases of renal clear cell carcinoma diagnosed by pathology after operation, and surgical margins were negative; there was 1 case of angiomyolipoma. There were no complications such as bleeding, urinary leakage or fever during the perioperative period. The serum creatinine before discharge was 99, 50, and 93 μmol/L, respectively. Conclusion Retroperitoneal partial nephrectomy and partial adrenalectomy can be carried out safely and effectively with this domestic single-port robotic surgical system. |
| Key words: robotic surgical procedures single-port laparoscopic surgery adrenal gland neoplasms kidney neoplasms partial adrenalectomy partial nephrectomy deformable surgical instrument |
