机器人辅助腹腔镜下肾部分切除术治疗肾门部肿瘤22例临床观察  

Robot-assisted partial nephrectomy for treating renal hilar tumors： a clinical study of 22 cases

作　　者：葛光炬[1] 丁国庆[1] 赵伟平[1] 马亮[1] 成晟[1] 陈元雷 李恭会[1] Ge Guangju;Ding Guoqing;Zhao Weiping;Ma Liang;Cheng Sheng;Chen Yuanlei;Li Gonghui(Department of Urology,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院泌尿外科,杭州310016

出　　处：《中华医学杂志》2018年第30期2438-2440,共3页National Medical Journal of China

摘　　要：目的分析并总结机器人辅助腹腔镜下肾部分切除术（RAPN）治疗肾门部肿瘤的手术经验，探讨该术式的疗效及安全性。方法回顾性分析浙江大学医学院附属邵逸夫医院2015年12月至2017年12月实施RAPN的22例肾门部肿瘤患者的临床资料，其中男19例，女3例，年龄28～75（55.6±13.0）岁。左肾门区肿瘤13例，右肾门区9例，大肿瘤（直径〉4 cm）10例，肿瘤大小（3.7±1.9） cm。术前肾小球滤过率均正常。结果22例手术均成功完成，无中转开放手术者。手术时间80～270（134.7±44.5）min；术中失血量80～500（135.9±130.7）ml，无术中输血；热缺血时间8～25（18.2±4.0）min;术后住院天数7～23（11.5±4.1）d。术后出现严重血尿1例，阵发性房颤1例。术后病理结果提示肾透明细胞癌18例，乳头状肾细胞癌2例，嫌色细胞癌1例，高分化神经内分泌癌1例，所有病例肿瘤切缘阴性。随访1～15（6.4±4.0）个月，无局部复发及远处转移，肾功能均正常。结论机器人辅助腹腔镜下肾部分切除术治疗肾门部肿瘤，具有创伤小、安全性高，疗效确切等优点，对于肾门部肿瘤，该术式在肿瘤的精确完整切除和肾脏创面的缝合上有较大的优势。ObjectiveTo analyze and summarize the surgical experience of robotic-assisted laparoscopic partial nephrectomy （RAPN） for treating renal hilar tumors, and assess the efficacy and safety of this surgery.MethodsThe clinical data of 22 renal hilar tumor patients who underwent RAPN in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine between September 2015 and September 2017 was analyzed. The patients included 19 males and 3 females, with an average age of （55.6 ±13.0） years old and the age range was 28-75 years. In 13 cases, the tumors were in left kidney, and 9 in the right. There were 10 large tumors （〉4 cm diameter）, the average tumor size was （3.7±1.9） cm. Preoperative glomerular filtration rate was normal in all cases.ResultsThe surgery was successfully finished in all of the cases, with no conversion to open surgery. The mean duration of the surgery was 80-270 min, with an average of （134.7±44.5） min. The blood loss was 80-500 ml, with an average of （135.9±130.7） ml, and none of the cases needed intraoperative blood transfusion. The warm ischemia time was 8-25 min, with an average of （18.2±4.0） min. The postoperative length of hospitalization was 7-23 d, with an average of （11.5±4.1） d. Serious gross hematuria occurred in 1 patient, and paroxysmal atrial fibrillation occurred in 1 patient after surgery. The post-operative pathology showed renal clear cell carcinoma in 18 cases, papillary renal cell carcinoma in 2 cases, chromophobe cell carcinoma in 1 case and well differentiated neuroendocrine tumor in 1 case. The tumor resection margin was negative in all cases. Neither local recurrence nor metastasis was observed during a follow-up of 1 to 15 months. Renal function of all the patients was in normal range.ConclusionRAPN is a safe, useful approach and a minimally invasive operation for treating renal hilar tumors and it owns crucial advantages in complete and accurate resection of the renal hilar tumors and the reconstruction of the kidney.

关 键 词：机器人 肾癌 肾部分切除术 微创手术 

分 类 号：R737.11[医药卫生—肿瘤]