经后腹腔与经腹腔入路机器人肾部分切除术的对照研究：单中心418例报告  

Comparison of transperitoneal and retroperitoneal robotic partial nephrectomy：a single center report of 418 cases

作　　者：吕香君[1] 张旭[1] 马鑫[1] 李宏召[1] 李新涛[1] 艾青[1] 刘启明[1] 黄双[1] 

机构地区：[1]解放军总医院泌尿外科,北京100853

出　　处：《中华泌尿外科杂志》2016年第9期641-646,共6页Chinese Journal of Urology

基　　金：国家高技术研究发展计划（863计划）（2012AA02101）

摘　　要：目的：对比经后腹腔与经腹腔入路机器人肾部分切除术的技术特点和临床疗效。方法选取2013年12月至2015年10月由同一术者连续完成的418例机器人肾部分切除术患者，其中采用经后腹腔入路（经后腹腔组）157例，经腹腔入路（经腹腔组）261例。经后腹腔组和经腹腔组患者的年龄（51岁vs.51岁，P＝0.593）、男／女比例（111／46例vs.186／75例，P＝0.184）、体重指数（25.5 kg／m^2 vs.25.6 kg／m^2，P＝0.331）、肿瘤左／右侧比例（80／77例vs.123／138例，P＝0.575）、肿瘤最大径（3.1 cm vs.3.5cm，P＝0.356）、孤立肾例数（18例vs.25例，P＝0.253）、双侧肿瘤例数（2例 vs.9例， P＝0.179）、术前肌酐（74.7μmol／L vs.76.7μmol／L，P＝0.736）、R.E.N.A.L.评分（6分 vs.6分， P＝0.083）和美国麻醉师协会评分（2分vs.2分，P＝0.310）等比较差异均无统计学意义。经后腹腔组和经腹腔组患者既往有腹部手术史的例数分别为34例和37例，差异有统计学意义（ P＝0.049）。经后腹腔组肿瘤位于肾腹侧9例，背侧140例，其他位置8例；经腹腔组肿瘤位于肾腹侧212例，背侧36例，其他位置13例，两组比较差异有统计学意义（ P＜0.05）。结果经后腹腔组和经腹腔组的中位手术时间（105 min vs.115 min，P＝0.041）、中位热缺血时间（15 min vs.20 min，P＜0.001）、术中估计出血量（50 ml vs.75 ml，P＜0.001）比较差异有统计学意义；术后24 h内出血量（45 ml vs.50 ml， P＝0.093）、术中输血例数（4例 vs.17例，P ＝0.072）和集合系统损伤例数（39例 vs.72例，P ＝0.539）比较差异无统计学意义。经后腹腔组25例（15.9％）发生腹膜破裂，使用Hem-o-lok进行破口修补。经腹腔组1例损伤肠道，于术中发现后行修补；2例损伤肝脏；5例损伤脾脏，均在腔镜下修补止血，其中1例行脾切除术。经后腹腔组和经腹腔组分别有3例（1.9％）和9例（Objective To conclude and compare the technical characteristics and clinical efficacy of retroperitoneal and transperitoneal approach for robotic partial nephrectomy.Methods 418 patients received robotic partial nephrectomy conducted by one surgeon in the urology department of PLA General Hospital from 2013, December to 2015, October, including 157 cases in retroperitoneal approach and 261 cases in transperitoneal approach.There were no significant difference between the transperitoeal and retroperitoneal approach in patient age（51 years, 51 years, P=0.593）, BMI（25.5 kg/m^2,25.6 kg/m^2, P=0.331）, gender（male/female：111/46,186/75,P=0.184）, location（left/right,80/77,123/138,P=0.575）, tumor size（3.1cm,3.5cm,P =0.356）, comorbidities, proportion of solitary kidney（11.5%, 9.6%,P=0.253） or bilateral tumors（1.3%,3.4%,P=0.179）, RENAL score（6（5-8）,6（5-8）,P=0.083）, ASA score（2 vs.2）（P=0.310） and preoperative serum creatinine（74.7 μmol/L,76.7 μmol/L, P=0.736）.Patients in the retroperitoeal approach group were more likely to have abdomen surgery history （21.7%,14.2%,P=0.049）.there was significant difference between two approaches in tumor location in the kidney （ anterior/posterior/others： 9/140/8, 212/36/13, P 〈0.001 ） Results The operation time （105min, 115min, P =0.041 ） and warm ischemia time （ 15min, 20min, P 〈0.001 ） were shorter and estimated blood loss（50ml,75ml,P〈0.001） was less in the retroperitoneal group.No significant difference was observed in postoperative 24h blood loss（45ml,50ml,P =0.093）, intraoperative transfusion rate （2.5%,6.5%,P=0.072） and collective system injury（24.8%,27.6%,P =0.539） between the two groups.Peritoneum break occurred in 25 cases in retroperitoneal group, which were repaired by Hem-o-lock.One intestinal injury occurred in transperitoneal group and was repaired intraoperatively.Three and nine cases in the retroperitoneal and transperitoneal group were converted to radical nephrectomy.One case in

关 键 词：机器人手术 肾肿瘤 肾部分切除术 经后腹腔手术 

分 类 号：R737.11[医药卫生—肿瘤]