机器人辅助腹腔镜肾分支动脉分步阻断保留肾单位手术在治疗巨大复杂肾癌中的应用  

Gradually clamping of renal branch arteries in robot-assisted laparoscopic nephron sparing surgery for large complex kidney tumor

作　　者：陈旭[1] 韦锦焕[1] 周航[1] 陈炜[1] 罗俊航[1] Chen Xu;Wei Jinhuan;Zhou Hang;Chen Wei;Luo Junhang(Department of Urology,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院泌尿外科,广州510080

出　　处：《中华腔镜泌尿外科杂志（电子版）》2021年第2期89-92,共4页Chinese Journal of Endourology(Electronic Edition)

基　　金：中山大学附属第一医院“五个五”工程项目。

摘　　要：目的巨大复杂肾癌的保肾手术难点在于既要完整切除巨大肿瘤,确切缝合大而深的创面及肾脏重建,同时又要避免肾脏热缺血时间过长。本文报告应用肾动脉分级阻断分步开放的优化肾血管阻断技术并结合机器人辅助腹腔镜操作精细分离和缝合的优势,较好地解决了这一难题,为此类复杂手术提供新思路。方法我院对一例56岁男性T2期R.E.N.A.L评分11分的巨大复杂肾癌患者运用机器人辅助下肾动脉分级阻断分步开放技术成功实施肾部分切除术。结果手术顺利完成,术后随访1个月和半年,复查患肾形态恢复,肾功能正常,未见肿瘤复发。结论对巨大复杂肾癌可利用机器人辅助肾动脉分级阻断分步开放技术实现在保证肿瘤完整切除基础上,最大程度减少肾热缺血时间,减少围术期并发症发生,具有临床推广应用价值。Objective The difficulty of nephron sparing surgery for large and complex kidney tumor lies in removing tumor completely and reconstructing of large and deep wounds precisely in limited renal ischemia time.The article reported that the experiences of utilizing gradually clamping renal branch arteries by robot-assisted laparoscopic surgery to solve the problem,providing a de-novo option for such kind of complicate operation.Methods Partial nephrectomy was performed on a case of 56-year-old man with a T2 stage,R.E.N.A.L score of 11 renal tumor by using robot-assisted laparoscopic gradually clamping renal branch arteries surgery technique.Results The operation was successfully completed,and organ shape mostly recovered along with normal renal function and no tumor recurrence in one month and halfa year postoperative follow up.Conclusion Gradually clamping of renal branch arteries in robot-assisted laparoscopic nephron sparing surgery can be used for large and complex renal mass to ensure complete tumor resection,minimize renal ischemia time and reduce perioperative complications,which deserving the clinical expansion application.

关 键 词：肾肿瘤 肾动脉阻断 保留肾单位手术 机器人 腹腔镜 三维重建 

分 类 号：R737.11[医药卫生—肿瘤]