机器人辅助腹腔镜肾部分切除术治疗PADUA评分≥10分的肾脏肿瘤  

da Vinci robot-assisted laparoscopic partial nephrectomy for renal tumors with PADUA score≥10

作　　者：叶华茂[1] 王蓉[2] 吴震杰[1] 李明敏[3] 蔡晨[4] 吕晨[1] 王林辉[1] 孙颖浩[1] 

机构地区：[1]第二军医大学长海医院泌尿外科,上海200433 [2]上海市第七人民医院外三科,上海200137 [3]第二军医大学长海医院放射科,上海200433 [4]第二军医大学长海医院特需诊疗科,上海200433

出　　处：《第二军医大学学报》2014年第7期800-803,共4页Academic Journal of Second Military Medical University

基　　金：国家自然科学基金面上项目(81272817);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(13XD1400100);上海市"领军人才"计划项目(2013046;WLH);长海医院"1255"学科建设计划项目(CH125520300);浦东新区卫生系统优秀青年医学人才培养项目(PWRq2012-11)~~

摘　　要：目的总结达芬奇机器人辅助腹腔镜肾部分切除术治疗PADUA评分≥10分肾肿瘤的手术疗效,评估其安全性、可行性,探讨其潜在的临床应用价值。方法通过分析2012年5月至2013年9月长海医院同一术者完成的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32-72岁,平均（52.3±10.1）岁;体质指数（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）,术前肾小球滤过率估计值（estimated glomerular filtration rate,eGFR）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例患者手术均顺利完成,无中转手术,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（50-1 000）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）个月,37例患者均存活,未发现局部复发或远处转移,eGFR平均下降8%,与术前相比差异有统计学意义（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,但肿瘤控制效果需进一步随访观察。Objective To evaluate the safety,feasibility and efficacy of da Vinci robot-assisted laparoscopic partial nephrectomy in treating renal tumors with PADUA score≥10,so as to discuss its clinical potential.Methods Between May 2012 and September 2013,da Vinci robot-assisted laparoscopic partial nephrectomy was performed for 37 renal tumors withPADUA score≥10 by a single urologist in our institution.The information of the patients were：age 52.3±10.1（32-72）years old;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）;and tumor laterality（L/R）20/17.The tumors were unilateral and solitary lesions,with a mean diameter of 4.2±1.19（2.1-7.2）cm,a PADUA score of 10.8±0.87（10-13）,and a preoperative estimated glomerular filtration rate（eGFR）of 101.2±25.58（46.6-198.7）mL/（min·1.73m2）.The renal arteries veins,and renal surroundings were isolated and the tumors were excised with or without blocking renal pedicle;all these procedures together with renorrhaphy were done by da Vinci robot-assisted laparoscopic techniques.Results All the 37 cases were smoothly done without surgical conversion,intraoperative complications or transfusion.The mean operative time was 241±50.0（120-330）min,estimated blood loss was 185±169.9（50-1 000）mL,and renal ischemia time was 26.7±9.90（0-50）min.The mean postoperative hospital stay was 11.4±3.44（8-19）days,with an overall complication rate of 13.5%（5/37）.Pathological examination revealed no positive surgical margin,and there were 28 cases of renal clear cell carcinoma,3 papillary cell carcinoma,and 5different types of benign lesions.All the patients were alive during a mean follow-up of 5.9±4.64（1-12）months,with no local recurrence or distant metastasis.Nevertheless,eGFR was decreased by a mean of 8%,showing significant difference compared with that before operation（Z=-2.883,P=0.004）.Conclusion For high PADUA score renal tumors,da Vinci robot-assisted laparoscopic partial nephre

关 键 词：机器人 保留肾单位手术 评分系统 腹腔镜检查 

分 类 号：R737.11[医药卫生—肿瘤]