机器人肾部分切除术中转为根治性肾切除术的影响因素分析  

Influencing factors of conversion from robot-assisted partial nephrectomy to radical nephrectomy

作　　者：洪国栋 于栓宝 崔金山 李振浩 陶金[1] 范雅峰 董彪[1] 张雪培[1,2] HONG Guodong;YU Shuanbao;CUI Jinshan;LI Zhenhao;TAO Jin;FAN Yafeng;DONG Biao;ZHANG Xuepei(Department of Urology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052;Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院泌尿外科,河南郑州450052 [2]河南省慢性肾脏疾病精准诊疗重点实验室,河南郑州450052

出　　处：《现代泌尿外科杂志》2023年第5期377-381,共5页Journal of Modern Urology

基　　金：河南省医学科技攻关计划联合共建项目(No.LHGJ20200334、LHGJ20190181);河南省高等学校重点科研项目(No.22A320028);河南省医学科技攻关省部共建重点项目(No.SBGJ202102140)。

摘　　要：目的探讨机器人肾部分切除术中转为根治性肾切除术的影响因素。方法回顾性收集郑州大学第一附属医院2015-2020年计划行机器人肾部分切除术的488例患者的临床资料及手术记录,根据术中是否中转为根治性肾切除术分为中转组和未中转组,比较两组的相关临床资料,分析术中转为根治性肾切除术的原因及影响因素。结果488例患者中14例(2.9%)中转为根治性肾切除术。机器人肾部分切除术中转为肾根治性切除的原因包括:①肿瘤解剖复杂,手术困难;②术中怀疑为局部晚期肾肿瘤;③术中出血较严重。单因素分析表明R.E.N.A.L.评分(P<0.001)、E值(P<0.001)、N值(P<0.001)、L值(P<0.001)、肾门位置(P<0.001)和T分期(P=0.002)为术中转为根治性肾切除术的影响因素。结论机器人肾部分切除术中转为根治性肾切除术的原因主要为肿瘤解剖复杂、术中怀疑为局部晚期肾肿瘤和术中严重出血等,R.E.N.A.L.评分、E值、N值、L值、肾门位置与T分期为机器人肾部分切除术中转为根治性肾切除术的影响因素。Objective To explore the influencing factors of planned robot-assisted partial nephrectomy(RAPN)converted to radical nephrectomy(RN).Methods Clinical data and operation records of 488 patients planned for RAPN in our hospital during 2015 and 2020 were retrospectively collected.The patients were divided into converted and unconverted groups,and relevant clinical data of the two groups were compared.The causes and influencing factors for conversion were analyzed.Results Among the 488 patients,14(2.9%)converted to RN.The causes included:①complicated tumor anatomy and surgical difficulties;②local advanced renal tumor suspected during operation;③severe intraoperative hemorrhage.Univariate analysis showed that R.E.N.A.L score(P<0.001),E value(P<0.001),N value(P<0.001),L value(P<0.001),renal hilum position(P<0.001)and T stage(P=0.002)were influencing factors of conversion.Conclusion Causes for the conversion of RAPN to RN include complicated tumor anatomy,suspected local advanced renal tumor and severe intraoperative hemorrhage.The R.E.N.A.L score,E value,N value,L value,renal hilum position and T stage are influencing factors.

关 键 词：机器人 肾部分切除术 中转根治性肾切除术 影响因素 

分 类 号：R692[医药卫生—泌尿科学]