改良腹膜后淋巴结清扫术在机器人辅助腹腔镜肾盂癌根治术中的应用  

Application of modified retroperitoneal lymphadenectomy in robot-assisted nephroureterectomy

作　　者：纪昊 李鹏超[1,2] 吉剑波 吴启开[1] 蔡令凯 曹强 杨潇[1] 吕强[1] Ji Hao;Li Pengchao;Ji Jianbo;Wu Qikai;Cai Lingkai;Cao Qiang;Yang Xiao;Lyu Qiang(Department of Urology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Urology,PuKou Branch Hospital of Jiangsu Province Hospital,Nanjing 211899,China;Department of Urology,Yancheng Third People′s Hospital,Yancheng 224008,China)

机构地区：[1]南京医科大学第一附属医院泌尿外科,南京210029 [2]江苏省人民医院浦口分院(南京市浦口区中心医院)泌尿外科,南京211899 [3]盐城市第三人民医院泌尿外科,盐城224008

出　　处：《国际泌尿系统杂志》2023年第1期9-12,共4页International Journal of Urology and Nephrology

基　　金：南京市卫生科技发展专项(YKK19146);浦口区社会事业科技发展计划项目(S2020-1);江苏省人民医院浦口分院科技发展基金资助(KJ2021-2)。

摘　　要：目的探讨机器人辅助腹腔镜改良腹膜后淋巴结清扫术在治疗肾盂和上段输尿管肿瘤患者中的手术技巧,总结短期疗效。方法回顾性分析2019年1月至2022年1月由南京医科大学第一附属医院收治的22例高危肾盂和(或)上段输尿管肿瘤患者的临床资料,患者均接受机器人辅助腹腔镜肾盂癌根治术+改良腹膜后淋巴结清扫术治疗。左侧清扫范围包括肾门、腹主动脉表面、腹主动脉旁淋巴结,右侧包括肾门、下腔静脉表面、下腔静脉旁、下腔静脉后、腹主动脉下腔静脉间淋巴结。结果患者手术时间为(138±14)min,清扫淋巴结(14.0±4.5)枚,18.2%(4/22)的患者为淋巴结阳性。随访(14.3±6.3)个月,其中2例患者出现膀胱内肿瘤复发,1例淋巴结转移患者死于肺转移。结论机器人辅助腹腔镜改良腹膜后淋巴结清扫术安全可行,对显露肾门、下腔静脉后方、腹主动脉下腔静脉间淋巴结的效果令人满意。Objective To explore the surgical technique of robot-assisted modified retroperitoneal lymph node dissection(LND)in patients with renal pelvic and upper ureteral tumors,and summarize the short-term efficacy.Methods The clinical data of 22 patients with high-risk renal pelvic and/or upper ureteral tumors who received robot-assisted nephroureterectomy with modified retroperitoneal LND from January 2019 to January 2022 at the first affiliated hospital of Nanjing medical university were retrospectively analyzed.For tumors located on the left side,the left renal hilar,preaortic and paraaortic nodes were dissected.The right renal hilar,precaval,paracaval,retrocaval,and interaortocaval nodes were removed for tumors on the right side.Results The operative time was(138±14)min.The number of lymph nodes removed was(14.0±4.5),with positive lymph nodes in 18.2%(4/22)patients.During a follow-up of(14.3±6.3)months,two patients experienced intravesical recurrences,and one patient with lymph node metastasis died of lung metastasis.Conclusions Robot-assisted retroperitoneal LND is safe and feasible,with satisfied exposure of the hilar,retrocaval and interaortocaval nodes.

关 键 词：肾肿瘤 肾盂 淋巴结切除术 腹腔镜检查 肾切除术 

分 类 号：R737.11[医药卫生—肿瘤]