腹腔镜达芬奇机器人手术治疗早期肾癌患者不同入路方式的效果比较  

Comparison of different approaches of laparoscopic Da Vinci robotic surgery in the treatment of patients with early renal cell carcinoma

作　　者：马磊[1] 韩春光 熊坤 朱国栋[1] MA Lei;HAN Chun-guang;XIONG Kun(不详;Department of Anesthesia and Surgery,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院麻醉手术部,陕西西安710061

出　　处：《中国医学装备》2022年第7期94-98,共5页China Medical Equipment

基　　金：陕西省重点研发项目(2020SF-119)“腹腔镜达芬奇机器人手术治疗早期肾癌患者不同入路方式的效果比较”。

摘　　要：目的:研究腹腔镜达芬奇机器人手术治疗早期肾癌患者不同入路方式的效果。方法:选取在医院接受手术治疗的80例早期肾癌患者,按照随机数表法将其分为腹膜后入路组和腹腔入路组,每组40例。腹膜后入路组采用经腹膜后入路方式进行腹腔镜达芬奇机器人手术,腹腔入路组采用经腹腔入路进行腹腔镜达芬奇机器人手术,比较两组围术期手术时间、出血总量、切口长度、术后排气时间、住院时间、中转开放手术率及切缘阳性率指标,比较两组治疗前后应激指标中丙二醛(MAD)、晚期氧化蛋白产物(AOPP)、肾上腺素(E)以及肿瘤标志物中糖类抗原50(CA50)、糖类抗原125(CA125)、癌胚抗原(CEA)水平,观察两组术后并发症发生率。结果:腹膜后入路组手术出血总量、切口长度、术后排气时间及住院时间显著低于腹腔入路组,差异有统计学意义(t=3.355,t=6.849,t=5.455,t=2.965;P<0.05);腹膜后入路组手术后MAD、AOPP及E水平显著高于手术前,差异有统计学意义(t=5.818,t=4.654,t=5.063;P<0.05);腹膜后入路组手术后MAD、AOPP及E水平显著低于腹腔入路组,差异有统计学意义(t=3.550,t=2.972,t=2.124;P<0.05)。两组术后CA50、CEA及CA125均显著低于术前,差异有统计学意义(t_(腹膜后入路组)=26.050,t=17.457,t=23.016;t_(腹腔入路组)=27.576,t=18.642,t=25.904;P<0.01)。腹膜后入路组术后并发症总发生率为22.50%,与腹腔入路组的30.00%比较,差异无统计学意义。结论:经腹膜后入路方式进行腹腔镜达芬奇机器人手术可明显减少早期肾癌患者手术创伤,且不影响其安全性和手术效果,值得临床推广。Objective:To study the effect of different approaches of laparoscopic Da Vinci robotic surgery in treating patients with early renal cell carcinoma.Methods:80 patients with early renal cell carcinoma in hospital were selected and they were randomly divided into group A and group B according to the random number table method,with 40 cases in each group.Group A used retroperitoneal approach for laparoscopic Da Vinci robot surgery,and group B used abdominal approach for laparoscopic Da Vinci robot surgery.The perioperative indexes(operation time,total amount of bleeding,incision length,postoperative exhaust time,the time of hospital stay,the rate of open surgery of transfer,positive rate of incision margin)between the two groups were compared.The stress indexes included malondialdehyde(MAD),advanced oxidation protein product(AOPP)and epinephrine(E),and tumor markers included carbohydrate antigen 50(CA50),carbohydrate antigen 125(CA125),carcinoembryonic antigen(CEA)of the two groups between before and after treatment were compared,and the incidence of complication between the two groups was compared.Results:The total amount of bleeding,incision length,postoperative exhaust time and the time of hospital stay in group A were significantly lower than those in group B,and the differences of them between two groups were statistically significant(t=3.355,t=6.849,t=5.455,t=2.965,P<0.05).The levels of MAD,AOPP and E in group A after surgery were significantly higher than those before surgery,and the differences of them between before and after surgery were statistically significant(t=5.818,t=4.654,t=5.063,P<0.05).The levels of MAD,AOPP and E after surgery in group A were significantly lower than those in group B(t=3.550,t=2.972,t=2.124,P<0.05).The levels of CA50,CEA and CA125 in the two groups after surgery were significantly lower than those before surgery(t_(group A)=26.050,t=17.457,t=23.016,t_(group B)=27.576,t=18.642,t=25.904,P<0.01).The total incidence of postoperative complications in group A was 22.50%,which was no si

关 键 词：腹腔镜 达芬奇机器人 早期肾癌 经腹膜后入路 

分 类 号：R737.11[医药卫生—肿瘤]