后腹膜机器人与腹腔镜肾肿瘤部分切除术:一项单一外科医生围手术期疗效的配对比较  

Retroperitoneal robotic versus laparoscopic partial nephrectomy for renal tumors:a matched comparison of perioperative outcomes of a single surgeon

作　　者：徐一帆 夏丹[1] 孟宏舟[1] 秦杰[1] 孔德波[1] 景泰乐[1] 叶孙益[1] 来翀[1] 汪朔[1] 王平[1] XU Yifan;XIA Dan;MENG Hongzhou;QIN Jie;KONG Debo;JING Taile;YE Sunyi;LAI Chong;WANG Shuo;WANG Ping(Department of Urology,the First Affiliated Hospital,Medical College of Zhejiang University,Hangzhou 310003,China)

机构地区：[1]浙江大学医学院附属第一医院泌尿外科,浙江杭州310003

出　　处：《机器人外科学杂志（中英文）》2023年第4期333-342,共10页Chinese Journal of Robotic Surgery

基　　金：国家自然科学基金(81772270)。

摘　　要：目的:应用R.E.N.A.L.肾功能评分系统进行配对分析,比较腹膜后腹腔镜肾部分切除术(Laparoscopic Partial Nephrectomy,LPN)与机器人肾部分切除术(Robot-assisted Partial Nephrectomy,RPN)的围手术期疗效。方法:对2016年1月—2020年3月543例于浙江大学医学院附属第一医院泌尿外科行腹腔镜及机器人辅助肾部分切除术患者的相关临床资料进行分析。根据R.E.N.A.L.肾功能评分、性别和年龄进行1∶1配对(112对配对),通过统计分析对围手术期结果进行比较。结果:LPN组和RPN组在年龄、性别、体重指数(Body Mass Index,BMI)、肿瘤大小、美国麻醉学家协会(American Society of Anesthesiologists,ASA)评分和术前估算肾小球滤过率(Estimated Glomerular Filtration Rate,eGFR)方面均无显著差异。接受LPN的患者左侧肿瘤所占比例略高(51.7%Vs42.9%,P=0.032)。两组在手术时间、术中出血量、术后住院时间(Length of Stay,LOS)、术后eGFR、输血量和/或术后并发症等方面均无显著差异。RPN组热缺血时间(Warm Ischemia Time,WIT)明显比LPN组短(18.9 min Vs22.6 min,P=0.032)。以复杂性为特点的亚集分析显示,复杂肿瘤RPN的WIT显著短于LPN(21.1 min Vs 26.3 min,P=0.012),而单纯性肿瘤RPN与LPN的WIT差异无统计学意义(16.4 min Vs 18.3 min,P=0.085)。结论:经腹膜后RPN手术时间较经腹膜后LPN短,但二者围手术期效果基本相同。在有限的腹膜后工作空间内进行复杂的肿瘤切除和修补,机器人辅助手术可能比传统的腹腔镜术更具优势。Objective:To compare the perioperative outcomes of patients undergoing retroperitoneal laparoscopic partial nephrectomy(LPN)and retroperitoneal robot-assisted partial nephrectomy(RPN)by matched analysis using R.E.N.A.L.nephrometry scoring system.Methods:Relevant clinical data of 543 case of laparoscopic and robot-assisted partial nephrectomy performed by a single surgeon via the RP approach from January 2016 to March 2020 from our database were screened and analyzed.Two groups were matched 1:1(112 matched pairs)by R.E.N.A.L.nephrometry score,gender,and age.Statistical analysis was done to compare perioperative outcomes.Results:There was no significant difference between the LPN group and RPN group in terms of age,gender,body mass index(BMI),tumor size,American Society of Anesthesiologists(ASA)score or preoperative estimated glomerular filtration rate(eGFR).Patients undergoing LPN had a slightly higher proportion of the left side tumor(51.7%Vs 42.9%,P=0.032).No significant differences regarding to operative time,estimated blood loss,postoperative LOS,postoperative eGFR,transfusion or postoperative complications were found between the two groups.However,Warm ischemia times(WIT)in the RPN group were significantly shorter than that in the LPN group(18.9 min Vs 22.6 min,P=0.032).Subset analysis based on complexity indicated that WIT of complex tumors in the RPN group was significantly shorter than that in the LPN group(21.1 min Vs 26.3 min,P=0.012),but no difference of WIT was found on simple tumors between the RPN group and LPN group(16.4 min Vs 18.3 min,P=0.085).Conclusion:Retroperitoneal RPN showed shorter WIT and generally equivalent perioperative results to retroperitoneal LPN.Robotic surgery may have advantages over the traditional laparoscopic surgery on complex tumor excision and renorrhaphy in the limited retroperitoneal space.

关 键 词：肾细胞癌 肾部分切除术 腹腔镜手术 机器人辅助手术 

分 类 号：R608[医药卫生—外科学] R737[医药卫生—临床医学]