机器人辅助腹腔镜与腹腔镜肾部分切除术治疗完全内生型肾肿瘤的疗效比较  

Analysis of robot-assisted laparoscopic versus laparoscopic partial nephrectomy for the treatment of completely endophytic renal tumors

作　　者：陈路遥 熊思途 邓文 熊芸强 陈涛[1] 詹祥鹏 刘伟鹏[1] 曾瑾 熊晶[1] 王共先[1] 傅斌[1] Chen Luyao;Xiong Situ;Deng Wen;Xiong Yunqiang;Chen Tao;Zhan Xiangpeng;Liu Weipeng;Zeng Jin;Xiong Jing;Wang Gongxian;Fu Bin(Department of Urology,First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Jiangxi Institute of Urology,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院泌尿外科,南昌330006 [2]江西省泌尿外科研究所,南昌330006

出　　处：《中华泌尿外科杂志》2022年第5期335-338,共4页Chinese Journal of Urology

基　　金：江西省卫生健康委科技计划(20203205)。

摘　　要：目的比较机器人辅助腹腔镜肾部分切除术(RAPN)与腹腔镜肾部分切除术(LPN)治疗完全内生型肾肿瘤的疗效。方法回顾性分析2015年1月至2021年6月南昌大学第一附属医院行RAPN或LPN的73例完全内生型肾肿瘤患者的临床资料。RAPN组29例,男21例,女8例;年龄(48.6±13.7)岁,肿瘤最大径(2.9±0.9)cm;左侧13例,右侧16例;R.E.N.A.L.评分(9.2±1.0)分;术前估算肾小球滤过率(eGFR)(82.6±10.7)ml/(min·1.73 m^(2))。LPN组44例,男27例,女17例;年龄(50.1±12.3)岁;肿瘤最大径(2.9±0.9)cm;左侧24例,右侧20例;R.E.N.A.L.评分(9.1±1.3)分;术前eGFR(81.7±9.6)ml/(min·1.73 m^(2))。两组术前一般资料差异均无统计学意义(P>0.05)。比较两组手术时间、热缺血时间、术中出血量、术后住院时间、术后并发症及术后3个月eGFR变化情况。结果两组均无中转开放及根治手术病例。RAPN组与LPN组手术时间[140(80,160)min与150(90,180)min,P=0.264]、术中出血量[150(100,200)ml与180(120,200)ml,P=0.576]及术后住院时间[(7.0±2.7)d与(7.4±2.1)d,P=0.480]差异均无统计学意义。RAPN组热缺血时间显著低于LPN组[(23.1±3.3)min与(27.6±4.7)min,P<0.001]。RAPN组术后未出现明显并发症,LPN组术后1例活动性出血,两组并发症发生率差异无统计学意义(P>0.05)。两组均无切缘阳性病例。两组术后3个月eGFR差异无统计学意义[(73.2±6.3)ml/(min·1.73 m^(2))与(70.5±7.6)ml/(min·1.73 m^(2)),P=0.117]。中位随访22.6(6.0~93.2)个月,两组均未见肿瘤复发及转移病例。结论对于经验丰富的术者,RAPN和LPN治疗完全内生型肾肿瘤均有较好的安全性和可行性。与LPN相比,RAPN可以降低完全内生型肾肿瘤的手术难度,缩短肾脏热缺血时间,围术期疗效有一定的优势。Objective To compare the efficacy and safety of robot-assisted laparoscopic and laparoscopic partial nephrectomy(RAPN and LPN)for patients with completely endophytic renal tumor.Methods A total of 73 patients with completely endophytic renal tumor receiving RAPN(n=29)or LPN(n=44)in our center between January 2015 and June 2021 were retrospectively collected.There were 21 males and 8 females in RAPN group.The average age was 48.6±13.7 years old,average tumor size was 2.9±0.9 cm with 13 left tumors and 16 right tumors,average R.E.N.A.L.score was 9.2±1.0,and average preoperative eGFR was 82.6±10.7 ml/(min·1.73 m^(2)).There were 27 males and 17 females in LPN group.The average age was 50.1±12.3 years old,average tumor size was 2.9±0.9 cm with 24 left tumors and 20 right tumors,average R.E.N.A.L.score was 9.1±1.3,and average preoperative eGFR was 81.7±9.6 ml/(min·1.73 m^(2)).There was no significant difference in above variables between two groups.The operative time,warm ischemia time,blood loss,postoperative complication,postoperative hospital stay and postoperative 3 months renal function of two groups were compared.Results All 73 patients successfully underwent RAPN or LPN and no patient converted to radical nephrectomy or open surgery.There was no significant difference in operation time[140(80,160)min vs.150(90,180)min,P=0.264],intraoperative estimated blood loss[150(100,200)vs.180(120,200)ml,P=0.576]and postoperative hospital stay(7.0±2.7 vs.7.4±2.1 days,P=0.480)between two groups.Compared with LPN group,RAPN group had obvious less warm ischemia time(23.1±3.3 vs.27.6±4.7 min,P<0.001).No obvious complication occurred in RAPN group and one case with postoperative hemorrhage occurred in LPN group.No positive margin occurred in either group.There was no difference in renal function 3 months after operation between the two groups[73.2±6.3 vs.70.5±7.6ml/(min·1.73 m^(2)),P=0.117].The median follow-up period was 22.6 months with no tumor recurrence or metastasis.Conclusions For experienced surgeons,both

关 键 词：肾肿瘤 完全内生型 机器人辅助 腹腔镜手术 肾部分切除术 

分 类 号：R737.11[医药卫生—肿瘤]