肾肿瘤内生型生长特性对机器人辅助腹腔镜下肾部分切除术近期疗效的影响  

Analysis of endophytic renal tumor growth characteristic on the outcomes of robot-assisted laparoscopic partial nephrectomy

作　　者：蒋国松[1] 李文成[1] 陈朝晖[1] 邢毅飞[1] 谌科[1] 杨军[1] 赵军[1] 肖亚军[1] 章小平[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院泌尿外科,武汉430022

出　　处：《中华泌尿外科杂志》2017年第3期166-169,共4页Chinese Journal of Urology

摘　　要：目的 探讨肾肿瘤内生型生长特性对机器人辅助腹腔镜下肾部分切除术近期疗效的影响.方法 回顾性分析2015年3月至2016年10月我们采用机器人辅助腹腔镜下肾部分切除术治疗的91例肾肿瘤患者的资料,其中内生型肿瘤（内生型组）23例,非内生型肿瘤（非内生型组）68例.两组患者的年龄、性别、肿瘤侧别、腹部手术史及肿瘤良恶性等方面比较差异均无统计学意义（均P＞0.05）,所有患者术前血肌酐值均正常.内生型组和非内生型组的肿瘤直径分别为（2.4 ±0.5）cm和（3.9±1.1）cm,差异有统计学意义（P＜0.05）.内生型组R.E.N.A.L评分4～6分3例、7～9分13例、10～12分7例,非内生型组R.E.N.A.L评分4～6分30例、7～9分29例、10～12分9例,差异有统计学意义（P＜0.05）.比较两组的围手术期情况及术后随访结果.同时满足热缺血时间＜ 25 min、肿瘤切缘阴性、无Clavien-DindoⅢ级以上严重并发症3项条件定义为Trifecta达标.结果 两组手术均顺利完成,均无中转开放或改行根治性肾切除手术病例.两组患者在术中出血量、术后血红蛋白下降值、术中及术后输血率、住院天数、肿瘤切缘阳性率、Clavien-DindoⅢ级以上并发症发生率等方面比较差异均无统计学意义（均P ＞0.05）.内生型组和非内生型组的手术时间分别为（95.6±19.4）min和（75.3±16.9）min;术中热缺血时间分别为（25.2 ±5.4）min和（17.6 ±7.0）min,差异均有统计学意义（均P ＜0.05）.内生型组12例Trifecta达标,非内生型组56例Trifecta达标,差异有统计学意义（P＜0.05）.术后随访3 ～22个月,两组患者均无瘤生存.结论 机器人辅助腹腔镜下肾部分切除术处理内生型肾肿瘤的近期疗效确切,远期疗效有待进一步观察.Objective To analyze the effect of endophytic renal tumor growth characteristic on the short-term outcomes of robot-assisted laparoscopic partial nephrectomy （RALPN）.Methods From March 2015 to October 2016,23 RALPN cases of endophytic renal masses and 68 RALPN cases of intermediate and exophytic renal tumors were retrospectively analyzed.There were no significant differences in age,gender,tumor side,history of abdominal surgery,benign and malignant cases of the two groups of patients （P 〉 0.05）.Patients with a completely endophytic mass had smaller tumors [（2.4 ± 0.5） cm vs.（3.9 ± 1.1） cm],and higher overall R.E.N.A.L.score （P 〈 0.05）.The differences of perioperative period and postoperative follow-up results were analyzed.Results All 91 RALPN cases were successfully done without conversion to open or radical nephrectomy.There were no significant differences in intraoperative blood loss,postoperative Hb decrease,intraoperative and postoperative blood transfusion rate,hospital days,positive tumor margins,and the incidence of Clavien-Dindo grade Ⅲ or above in the two groups （P 〉 0.05）.The endophytic group showed longer operative time [（95.6 ± 19.4） min vs.（75.3 ± 16.9） min],and longer renal warm ischemia [（25.2 ±5.4）min vs.（17.6 ±7.0）min].In the postoperative follow-up of 3 months to 22 months,all patients got disease-free survival.Conclusions RALPN for completely intraparenchymal renal tumors can be safely and effectively performed in experienced institutes.However,the long-term period of follow-up is still missing.

关 键 词：内生型肾肿瘤 机器人辅助腹腔镜 肾部分切除术 

分 类 号：R737.11[医药卫生—肿瘤]