达芬奇机器人辅助腹腔镜下肾部分切除术手术入路的新选择  

A new surgical approach for da Vinci robot-assisted laparoscopic partial nephrectomy

作　　者：梁朝朝[1] 周骏[1] 邰胜[1] 王建忠[1] 杨诚[1] 徐汉江[1] 徐凌凡[1] 施浩强[1] 郝宗耀[1] 

机构地区：[1]合肥安徽医科大学第一附属医院泌尿外科,230022

出　　处：《中华泌尿外科杂志》2016年第5期323-327,共5页Chinese Journal of Urology

基　　金：卫计委国家临床重点专科建设项目（泌尿外科,2012）,安徽省教育厅泌尿外科临床技能虚拟仿真实验教学中心项目（2014xnzx028）

摘　　要：目的总结经腰腹联合入路机器人辅助腹腔镜下肾部分切除术的手术方法，探讨机器人辅助腹腔镜下肾部分切除术手术入路的新选择。方法回顾性分析2015年6月至2016年1月收治的13例行经腰腹联合入路机器人辅助腹腔镜下肾部分切除术患者的临床资料，男7例，女6例。年龄26～74岁，平均48岁。肿瘤位于左肾8例，右肾5例。肿瘤直径2．5—4．5cm，平均3．5cm。其中1例患者左肾有2枚肿瘤，直径分别为1．5cm和3．0cm。所有患者术前均行CT检查，考虑为肾细胞癌，其中3例行双肾血管三维成像。术前行胸部x线片检查排除远处转移。13例术前血肌酐均在正常范围，2例伴2型糖尿病，2例伴高血压病。13例均行经腰腹入路腹腔镜下肾部分切除术。结果本组13例手术均顺利完成。手术时间80—140min，平均100min。术中热缺血时间15—28min，平均22min。术中出血40—120ml，平均60ml，无术中输血病例。术后病理诊断为肾透明细胞癌12例，肾血管平滑肌脂肪瘤1例，无切缘阳性病例。术后随访1—7个月，术后1、3个月复查肾功能均在正常范围，复查B超未见肿瘤残留和复发。结论经腰腹联合入路腹腔镜下肾部分切除术有效地将经腹膜外与经腹途径结合起来，既发挥了经腹膜外手术处理血管的优势，又满足了机器人手术对空间的要求，使其优势得以充分发挥。Objective To investigate the advantages of combination of retroperitoneal and peritoneal approach for robotic-assisted laparoscopic partial nephrectomy. Methods 7 male patients and 6 female patients, aging between 26-74, underwent robotic-assisted laparoscopic partial nephrectomy via combination of retroperitoneal and peritoneal approach between July 2015 and January 2016. Before surgery, 8 cases were found the lesions on the left side and the other 5 cases were found the lesions on the right side. The mean diameter of tumor was 3.5cm （ ranging from 2. 5 to 4. 5cm）. Among them, one case was observed two tumors on the left kidney whose diameter were 1.5 cm and 3.0cm, respectively. All the cases were considered as renal cell carcinoma via pre-operative CT scan, including 3 patients underwent CTA examination. Chest radiograph was undertaken to exclude distant metastasis. All patients showed normal serum creatinine level 2 patients suffered with type 11 diabetes and another 2 patients suffered with hypertension. Results All the operations were completed successfuUy. The median operation time was 100 rains （ranging from 80 to 140rains）. Ischemic time was 22 mins （ranging from 15 to 28mins）. Estimated blood loss was 60ml （ranging from 40 to 120ml） without blood transfusion. The pathology resuhs determined that 12 cases were diagnosed as clear cell renal cell carcinoma. 1 case was diagnosed as renal angiomyolipoma. All the cases were confirmed negative margin. The follow-up duration ranged from 1 to 7 months. Postoperative serum creatinine levels were normal both in 1 and 3 months after surgery. There was no sign of residue tumor or recurrence by ultrasound. Conclusions Combination of retrolaeritoneal andperitoneal approach can not only meet the space need for robot-assisted laparoscopic surgery but also enhance the advantage of blood vessel dealing via retroperitoneal approach . This promising approach is worthy of being widely used.

关 键 词：肾部分切除术 机器人辅助腹腔镜 手术途径 腰腹联合 

分 类 号：R737.11[医药卫生—肿瘤]