后腹腔镜、机器人腹腔镜、机器人后腹腔镜肾部分切除术的比较:单一术者经验  

Comparison Among Retroperitoneal Laparoscopic,Robotic-assist Laparoscopic and Robotic-assist Retroperitoneal Laparoscopic Partial Nephrectomy:Single Surgeon Experience

作　　者：王昕凝 祖强[1] 黄双[1] 卢锦山[1] 董隽[1] Wang Xinning;Zu Qiang;Huang Shuang(Department of Urology,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院泌尿外科,北京100853

出　　处：《中国微创外科杂志》2018年第10期874-877,898,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的比较机器人辅助腹腔镜肾部分切除术(robotic-assist laparoscopic partial nephrectomy,RALPN)、机器人辅助后腹腔镜肾部分切除术(robotic-assist retroperitoneal laparoscopic partial nephrectomy,RARPN)及传统后腹腔镜肾部分切除术(retroperitoneal laparoscopic partial nephrectomy,LPN)的疗效及安全性。方法回顾性分析2013年8月～2017年8月单一术者使用da Vinci机器人系统及Storz腹腔镜系统进行372例肾部分切除术的临床资料。其中RALPN 138例,RARPN 46例,LPN 188例。比较3组手术时间、术中失血量、肾动脉热缺血时间、术后并发症发生率及术后肿瘤复发转移率。结果 3组手术时间分别为(122.3±30.9)min、(112.5±28.7)min、(114.8±34.5)min,无统计学差异(F=2.682,P=0.070)。3组肾动脉阻断时间分别为(20.8±5.9)min、(19.4±5.1)min、(23.7±6.8)min(F=13.025,P=0.000),RALPN和RARPN明显短于LPN(P<0.05)。3组术中失血量分别为(89.0±76.9)ml、(42.9±40.3)ml、(55.2±86.6)ml(F=9.644,P=0.000),RALPN明显多于RARPN和LPN(P<0.05)。LPN组术中输血1例,RALPN及RARPN组均无术中输血。3组术后并发症发生率及术后肿瘤复发转移率无统计学差异(P>0.05)。结论机器人辅助腹腔镜手术及机器人辅助后腹腔镜手术均为安全、有效的手术方式。Objective To compare the efficiency and safety among robotic-assist laparoscopic partial nephrectomy （RALPN）, robotic-assist retroperitoneal laparoscopic partial nephrectomy （RARPN）, and retroperitoneal laparoscopic partial nephrectomy （LPN）. Methods A total of 372 patients, including 138 patients treated by RALPN, 46 patients treated by RARPN and 188 patients treated by LPN, from August 2013 to August 2017 by the single surgeon with the da Vinci Robot Surgical System or the Storz laparoscopic surgical instruments were reviewed and analyzed. The operation time, blood loss volume, warm ischemia time, postoperative complication rate and recurrence or metastasis rate among the three groups were compared. Results The operation time was （122.3 ± 30.9） rain, （112.5 ± 28.7） rain, and （114.8 ± 34.5） rain, respectively, without statistic difference among the three groups （F=2.682, P=0.070）. The warm ischemia time of the three groups was （20.8±5.9） rain, （19.4±5.1） rain, and （23.7 ± 6.8 ） rain, respectively, with statistic differences between RALPN or RARPN and LPN （ F = 13. 025, P = 0. 000）. The blood loss volume of the three groups was （ 89.0 ± 76.9） ml, （42.9 ± 40.3 ） ml, and （55.2 ± 86.6） ml, respectively, with statistic differences between RALPN and RARPN or LPN （ F = 9. 644, P = 0. 000） . One case in LPN group received intraoperative blood transfusion and there was no case in the RALPN or RARPN groups. There was no statistic difference among the three groups on postoperative recurrence or metastasis rate （P 〉 0.05）. Conclusion Both RALPN and RARPN are safe and efficient operations.

关 键 词：肾部分切除术 肾肿瘤 机器人 腹腔镜 

分 类 号：R737.11[医药卫生—肿瘤]