机器人辅助与开放手术 治疗肾癌并Mayo Ⅰ~Ⅲ 级下腔静脉癌栓的效果比较  

Comparison of robot-assisted and open surgery in the treatment of renal carcinoma with MayoⅠ-Ⅲinferior vena cava tumor thrombus

作　　者：朱阿丽[1] 陶金[1] 崔金山 王声政[1] 于栓宝 范雅峰 朱照伟[1] 董彪[1] 张雪培[1,2] ZHU Ali;TAO Jin;CUI Jinshan;WANG Shengzheng;YU Shuanbao;FAN Yafeng;ZHU Zhaowei;DONG Biao;ZHANG Xuepei(Department of Urology,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382-386,407,共6页Journal of Modern Urology

基　　金：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：目的比较机器人辅助与开放手术治疗肾癌并下腔静脉癌栓的临床疗效,分析机器人辅助根治性肾切除并腔静脉癌栓切除术治疗肾癌并下腔静脉癌栓的安全性和可行性。方法回顾性分析2015年12月-2021年12月由郑州大学第一附属医院同一术者收治的55例肾癌并MayoⅠ~Ⅲ级下腔静脉癌栓患者的临床资料。根据手术方式分为机器人辅助组(36例)和开放手术组(19例),比较两组的围术期资料、肿瘤学结果及生存情况。结果55例患者手术均顺利完成,手术中位时间176(IQR:137~234)min,9(16.4%)例患者围手术期并发症≥Ⅲ级。机器人手术组较开放手术组的术中出血量[300(200~625)mL vs.1000(600~1184)mL]、输血比例[(20/36)vs.(18/19)]低,而术后血红蛋白水平[109(98~120)g/L vs.90(84~100)g/L]较高。中位随访时间为26(IQR:19~39)个月,19(34.5%)例患者发生新发转移,12(21.8%)例患者死亡。两组(机器人辅助组vs.开放手术组)术后的肿瘤特异性生存时间(HR=0.39,95%CI:0.13~1.16,P=0.090)及总生存时间(HR=0.71,95%CI:0.22~2.23,P=0.554)比较差异无统计学意义。结论机器人辅助与开放手术治疗MayoⅠ~Ⅲ级下腔静脉癌栓的术后并发症、肿瘤无进展生存时间和总生存时间差异无统计学意义,但机器人辅助根治性肾切除并腔静脉癌栓切除术术中出血量低于开放手术。Objective To compare the clinical efficacy of robot-assisted and open surgery in the treatment of renal carcinoma with inferior vena cava cancer thrombus,and to analyze the safety and feasibility of robot-assisted radical nephrectomy.Methods Clinical data of 55 patients surgically treated for renal carcinoma with MayoⅠ-Ⅲinferior vena cava tumor thrombus during Dec.2015 and Dec.2021 were retrospectively analyzed.Based on the operation methods,the patients were divided into the robotic surgery group(n=36)and open surgery group(n=19).The perioperative data,oncological results and survival of the two groups were compared.Results All operations were successful.The median operation time was 176(IQR:137-234)min,and gradeⅢand above complications occurred in 9(16.4%)cases.The robotic surgery group had lower intraoperative blood loss[300(IQR:200-625)mL vs.1000(IQR:600-1184)mL]and blood transfusion ratio[(20/36)vs.(18/19)]than the open surgery group,but higher postoperative hemoglobin level[109(98-120)g/L vs.90(84-100)g/L].During a median follow-up of 26(IQR:19-39)months,19(34.5%)patients developed new metastases and 12(21.8%)patients died.The postoperative tumor-specific survival(HR=0.39,95%CI:0.13-1.16,P=0.090)and overall survival(HR=0.71,95%CI:0.22-2.23,P=0.554)were not significantly different between the two groups.Conclusion There are no significant differences in the incidence of postoperative complications,tumor-specific survival and overall survival between robot-assisted and open surgery for MayoⅠ-Ⅲinferior vena cava tumor thrombus,but the intraoperative blood loss in robotic group is lower than that in the open surgery group.

关 键 词：机器人 开放手术 下腔静脉癌栓 根治性肾切除 癌栓切除术 

分 类 号：R692[医药卫生—泌尿科学]