五类微创技术在局限性肾肿瘤保留肾单位手术中的临床应用特点和效果  

Comparison of perioperative outcomes of five minimally invasive approaches in nephron-sparing surgery for localized renal tumor

作　　者：王林辉[1] 徐逸凡[1] 刘冰[1] 叶华茂[2] 杨庆[2] 徐斌[2] 吴震杰[1] 孙颖浩[2] 

机构地区：[1]上海长征医院泌尿外科,上海200003 [2]上海长海医院泌尿外科

出　　处：《上海医学》2015年第7期573-578,共6页Shanghai Medical Journal

基　　金：国家自然科学基金面上项目(81272817;81172447);上海市科技人才计划(13XD1400100)资助项目

摘　　要：目的比较5类微创技术在局限性肾肿瘤保留肾单位手术中的临床应用特点和价值。方法回顾性分析2009年8月-2013年4月上海长海医院泌尿外科肾肿瘤临床诊治与研究专业组完成的196例肾肿瘤保留肾单位手术患者的临床资料，其中开放肾部分切除术30例（开放组）、普通腹腔镜下肾部分切除术82例（普通腹腔镜组）、后腹腔镜辅助小切口肾部分切除术28例（腹腔镜小切口组）、单孔腹腔镜下肾部分切除术7例（单孔腹腔镜组）、机器人外科手术系统辅助腹腔镜下肾部分切除术33例（机器人腹腔镜组）、肾脏肿瘤冷冻消融术16例（冷冻消融术组）。男129例，女67例，平均年龄为（51．0±12．9）岁，平均BMI为（24．3±3．11）kg／m^2，平均美国麻醉医师协会（ASA）分级为（1．9±0．4）级，平均肿瘤最大径为（3．3±1．3）cm，平均肿瘤DAP（Diameter-Axiab-Polar）评分为（5．8±1．5）分，Charlson全身合并症指数（CCI）0～6，中位CCI为0，平均估算肾小球滤过率（eGFR）为（103．1±33．1）mL·min^-1·1．73m^-2。分别以开放组和普通腹腔镜组为对照，两两比较各组间临床指标的差异。结果与开放组比较，普通腹腔镜组的肿瘤最大径和DAP评分、术中出血量、疼痛视觉模拟评分（VAS评分）、术后住院天数均显著减少（P值均〈0．01），缺血时间和标化缺血时间均显著延长（P值均〈0．01）；单孔腹腔镜组的BMI、肿瘤最大径和DAP评分、术中出血量、疼痛VAs评分均显著减少（P值分别〈0．05、0．01），标化缺血时间显著延长（P〈0．05）；机器人腹腔镜组的手术时间、标化缺血时间均显著延长（P值均〈0．01），术中出血量、疼痛VAS评分均显著减少（P值均〈0．01）；冷冻消融术组的年龄、CCI均显著增加（P值分别〈0．05、0．01），肿瘤最大径和DAP评分、术中出血量、疼痛VAS评分、术后�Objective To compare clinical outcomes of five minimally invasive approaches in nephron- sparing surgery （NSS） for localized renal tumor. Methods A total of 196 NSS patients who underwent surgical treatment by the specialized team of renal tumor at our institution between August 2009 and April 2013 were enrolled in this retrospective study. There were 30 cases of open partial nephrectomies （group A）, 82 cases of conventional laparoscopic partial nephrectomies （group B）, 28 cases of retroperitoneal laparoscope assisted miniincision partial nephrectomies （group C）, 7 cases of laparoendoscopic single-site partial nephrectomies （group D）, 33 cases of robot assisted laparoscopic partial nephrectomies （group E）, and 16 cases of cryoablation （group F）. There were 129 males and 67 females with an average age of （51.0 ±12.9） years. Their mean body mass index （BMI） was （24.3 ± 3.11 ） kg/m^2 , mean ASA score was 1.9 ±0.4, mean maximal diameter of the tumor was （3.3±1.3） cm, mean DAP score was 5.8- 1.5, median Charlson comorbidity index （COl） was 0 （0- 6）, and mean preoperative estimated glomerular filtration rate （eGFR） was （ 103. 1 ±33. 1 ） mL · min^-1· 1.73 m^-2 . Group A and B were taken as control groups. Comparisons of perioperative outcomes between the control and study groups were conducted. Results Compared with those in the group A, maximal tumor diameter, DAP score, intraoperative blood loss, VAS score and postoperative hospital stay were significantly decreased （all P〈 0.01）, while ischemia time and standardized ischemia time were significantly increased in group B （both P 〈0.01）, BMI, maximal tumor diameter, DAP score, intraoperative blood loss and VAS score were significantly decreased （ P〈0.05 or P〈0.01 ）, while standardized ischemia time was significantly increased in group D （ P〈 0.05）; operative time and standardized ischemia time were significantly increased （both P 〈0. 01 ）, while intraoperative blood loss a

关 键 词：保留肾单位手术 腹腔镜 单孔腹腔镜手术 机器人 冷冻消融术 

分 类 号：R737.11[医药卫生—肿瘤]