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作 者:邝金 陈光 丁兵 鲁雄兵[1] 张信基 KUANG Jin;CHEN Guang;DING Bing;LU Xiongbing;ZHANG Xinji(Department of Urology, Second Affiliated Hospital of Nanchang University, Nanchang 330006, China)
出 处:《现代泌尿生殖肿瘤杂志》2022年第1期4-7,30,共5页Journal of Contemporary Urologic and Reproductive Oncology
摘 要:目的分析应用机器人辅助腹腔镜对肾门肿瘤行保留肾单位手术的临床可行性及手术技巧。方法收集本中心2018年10月至2019年10月收治的14例肾门肿瘤患者行机器人腹腔镜下保留肾单位手术的资料,回顾性分析其临床数据并总结手术技巧。其中男9例,女5例;左侧肿瘤7例,右侧肿瘤7例;肿瘤最大直径平均为3.3(2.1~5.6)cm;术前R.E.N.A.L.评分平均为7.5(6.0~10.0)分;术前患肾GFR平均为43.6(32~54)ml/(min·1.73 m^(2))。结果14例手术均顺利完成。平均手术时间为118(90~200)min,平均肾动脉阻断时间为25(17~41)min,平均术中出血量为90(56~200)ml。术后平均肾周引流管留置时间为3.9(3~6)d,平均住院时间为5.1(4~9)d,均未出现泌尿系统相关并发症(血尿及尿漏)。病理回报:12例恶性肿瘤切缘均为阴性,其中肾透明细胞癌9例、乳头状肾细胞癌3例;2例为良性血管平滑肌脂肪瘤。术后6个月复查患肾GFR平均为32.3(25~49)ml/(min·1.73 m^(2)),14例均未出现复发及转移。结论应用机器人辅助腹腔镜,术前采用R.E.N.A.L.评分精确评估,术中选择合适的切除及缝合策略对肾门肿瘤行保留肾单位手术是可行且有效的。Objective To analyze the clinical feasibility and summarize operative skills of robot-assisted laparoscopic nephron sparing surgery(NSS)for hilar tumors.Methods The data of 14 renal hilar tumor patients admitted to our center from October 2018 to October 2019 who underwent robot-assisted laparoscopic NSS were collected and retrospectively analyzed,and operative skills were summarized.There were 9 males and 5 females.Tumors of 7 cases were on the left side,while others on the right.The average maximum diameter of hilar tumor was 3.3(2.1-5.6)cm.The average R.E.N.A.L.score was 7.5(6.0-10.0).The average preoperative GFR of the affected side was 43.6(32-54)ml/(min·1.73 m).Results All operations of 14 cases were successfully performed.The NSS operation time was 118(90-200)min on the average,and the average renal artery occlusion time was 25(17-41)min.The average intraoperative blood loss was 90(56-200)ml.The average perinephric drainage tube indwelling time was 3.9(3-6)days.The average postoperative hospital stay was 5.1(4-9)days.There were no urinary system-related complications(hematuria or urine leakage)after surgery.Pathological report:12 cases of malignant tumors were all negative at the margins,including 9 cases of renal clear cell carcinoma,3 cases of papillary renal cell carcinoma,and 2 cases of benign angiomyolipoma.The average GFR of the kidneys in the 6 months after surgery was 32.3(25-49)ml/(min·1.73 m).No recurrence or metastasis occurred.Conclusions As for hilar tumor,it is feasible and effective to perform robot-assisted laparoscopic NSS by preoperative R.E.N.A.L.evaluation,appropriate resection and suture strategy.
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