机器人辅助腹腔镜下零缺血免缝合保留肾单位手术的初步经验  

Preliminary experience of robot-assisted laparoscopic zero-ischemia and sutureless nephron-sparing surgery

作　　者：王宁[1] 汪金荣[1] 刘斌[1] 刘建业[1] 何乐业[1] WANG Ning;WANG Jinrong;LIU Bin;LIU Jianye;HE Leye(Department of Urology,the Third Xiangya Hospital of Central South U niversity,Changsha,410013,China)

机构地区：[1]中南大学湘雅三医院泌尿外科

出　　处：《临床泌尿外科杂志》2019年第11期901-904,共4页Journal of Clinical Urology

摘　　要：目的:探讨机器人辅助腹腔镜下零缺血免缝合保留肾单位手术(NSS)治疗肾脏肿瘤的安全性及有效性,以最大限度保留肾脏功能。方法:回顾性分析2018年3~5月在我院行机器人辅助腹腔镜下零缺血免缝合NSS的4例患者的临床资料。4例患者肿瘤直径均<4 cm。术中分离显露肾动脉,打开肾脂肪囊并清除肿瘤周围脂肪组织,充分游离肿瘤,距肿瘤0.5~1.0 cm用剪刀锐性完整切除肿瘤。创面采用双极电凝充分止血并留置止血材料。结果:4例手术顺利完成,术中均未阻断肾动脉并采用免缝合技术。手术时间97~235 min,术中出血量50~800 ml。术后4例患者留置腹腔或腹膜后引流管2~5 d。病理报告提示例1为血管平滑肌脂肪瘤,例2、3为乳头状肾细胞癌,例4为肾透明细胞癌。术后患者肌酐55~137μmol/L,较术前均未见升高。术后住院时间7~9 d。4例患者围术期均未发生并发症,术后顺利出院。结论:初步经验显示机器人辅助腹腔镜下零缺血免缝合NSS治疗一些特定的肾脏肿瘤安全可行,可最大限度保护患者肾功能。Objective:To explore the safety and efficiency of robot-assisted laparoscopic zero-ischemia sutureless nephron-sparing surgery(NSS),in order to conserve the function of kidney.Method:This retrospective analysis included the clinical data of 4 patients who received robot-assisted laparoscopic zero-ischemia sutureless NSS from March 2018 to May 2018 in Third Xiangya Hospital.The tumor diameter of these 4 patients was less than 4 centimeters.During the surgery,the renal artery was separated clearly and the tumor was exposed adequately.We dissected the tumor integrally with margin distance from 0.5 to 1.0 centimeter using scissors.Hemostasis was achieved by bipolar coagulation and hemostatic agents.Result:The four surgeries were finished successfully,with no renal artery being blocked.Hemostasis was controlled by a sutureless technique.Operation duration and estimated blood loss was respectively from 97 to 235 min and from 50 to 800 ml.Duration of drainage,length of stay and the level of creatinine after surgery was from 2 to 5 days,from 7 to 9 days and from 55 to 137μmol/L respectively.Pathological examination revealed angioleiomyolipoma in case No.1,papillary renal cell carcinoma in case No.2 and No.3,and suprarenal epithelioma in case No.4.There were no postoperative complications in the 4 patients who left hospital uneventfully.Conclusion:Preliminary experience indicates that it is safe and practical to apply robot-assisted laparoscopic zero-ischemia sutureless NSS to treat some specific renal tumors,protecting the renal function to the utmost.

关 键 词：机器人手术 免缝合技术 零缺血保留肾单位手术 肾脏肿瘤 

分 类 号：R737.11[医药卫生—肿瘤]