单术者机器人辅助腹腔镜肾部分切除术治疗完全内生型肾肿瘤38例临床分析  

Robot-assisted partial nephrectomy for totally intrarenal tumors： a single surgeon＇ s experience

作　　者：时佳子[1] 刘承宗[1] 王卫平[1] 董毅[1] 臧婉婷 吴震杰[1] 刘冰[1] 王林辉[1] Shi Jiazi;Liu Chengzong;Wang Weiping;Dong Yi;Zang Wanting;Wu Zhenjie;Liu Bing;Wang Linhui(Department of Urology, Shanghai Changzheng Hospital, Shanghai 200003, Chin)

机构地区：[1]上海长征医院泌尿外科,200003

出　　处：《中华泌尿外科杂志》2018年第6期419-421,共3页Chinese Journal of Urology

摘　　要：目的探讨机器人辅助腹腔镜肾部分切除术（RAPN）治疗完全内生型肾肿瘤的安全性和有效性。方法回顾性分析2012年8月至2017年12月由同一术者实施RAPN治疗的38例完全内生型肾肿瘤患者的临床资料。男25例，女13例；年龄（51.61 ± 11.76）岁；肿瘤位于右肾24例，左肾14例；肿瘤最大径（3.12±0.92）cm，R.E.N.A.L.评分（9.76±1.00）分；术前肌酐（74.82±20.32）μmol/L。分析手术时间、缺血时间、术中出血量、切缘阳性率、住院时间、并发症情况及术后病理结果、肾功能等指标。结果所有患者手术均顺利完成，无中转开放或行根治性肾切除术病例。19例术中应用超声进行肿瘤定位。手术总时间（188.47±46.75）min，缺血时间（24.32±7.69）min，术中出血量（115.79±43.66）ml，住院时间（13.58±3.07）d。术后1周血肌酐（85.97±28.33）μmol/L，与术前相比差异无统计学意义（P=0.138）。3例术后出血，其中1例予血管栓塞治疗，2例予保守治疗后均治愈。术后病理：透明细胞癌28例，嫌色细胞癌3例，TFE-3基因融合相关肾癌3例，后肾腺瘤1例，嗜酸性细胞腺瘤1例，血管平滑肌脂肪瘤2例。其中1例含囊性成分肾癌，术中切破肿瘤，切缘阳性。38例均获得随访，随访时间4-68个月，中位随访时间37个月，期间均无瘤生存。结论对于有经验的术者，RAPN治疗完全内生型肾肿瘤，出血等并发症发生率低，围手术期肾功能无明显变化，未见肿瘤复发转移，提示手术安全、可行，但远期疗效仍需进一步研究。ObjectiveTo investigate the safety and efficiency of robot-assisted partial nephrectomy （RAPN） for totally intrarenal tumors （TITs）.MethodsThirty-eight patients who underwent RAPN for treating TITs by one experienced surgeon were included between August 2012 and December 2017. There were 25 males and 13 females, aged 26-72 years（mean 51.6 years）. Tumors of 24 cases were in right kidney, and 14 cases in left kidney. The diameter of tumor was（3.12±0.92）cm, the R. E.N.A.L. score was（9.76±1.00）, and the Scr was（74.82±20.32）μmol/L. Patients’ peri-operative and oncological outcomes were analyzed.ResultsAll the tumors were successfully resected without conversion to open surgery or radical nephrectomy. Mean operative time and ischemia time were （188.47±46.75） min and （24.32±7.69） min. Mean blood loss was （115.79±43.66） ml. One-week postoperative Scr was （85.97±28.33） μmol/L. Postoperative hemorrhage was successfully treated by DSA or drug therapy in 3 patients. The pathological examination showed 28 clear cell renal cell carcinomas, 3 chromophobe renal cell carcinomas, 3 TFE-3 infusion related renal cell carcinomas, 2 metanephric adenomas, 1 acidophile adenoma and 2 angioleiomyolipomas. One positive surgical margin occurred in RAPN group for cystic components. No evidence of tumor progression observed during follow-up.ConclusionsRAPN is safe and effective in treating TITs when performed by an experienced surgeon at a high-volume institution. Further prospective and large-scale study was warranted to evaluate the long-term outcomes.

关 键 词：肾肿瘤 肾部分切除术 完全内生型 机器人 

分 类 号：R737.11[医药卫生—肿瘤]