经腹膜后途径机器人辅助腹腔镜下肾部分切除术治疗腹侧和背侧肾肿瘤的疗效分析  

Clinical efficacy of retroperitoneal robot-assisted laparoscopic partial nephrectomy for ventral and dorsal renal tumor

作　　者：陈浩楠 杨潇 刘沛昆 蔡令凯 庄俊涛 吴启开 曹强 李鹏超 吕强 CHEN Haonan;YANG Xiao;LIU Peikun;CAI Lingkai;ZHUANG Juntao;WU Qikai;CAO Qiang;LI Pengchao;LYU Qiang(Department of Urology,The First Affiliated Hospital of Nanjing Medical University(Jiangsu Province Hospital),Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院(江苏省人民医院)泌尿外科,江苏南京210029

出　　处：《现代泌尿外科杂志》2024年第7期581-585,592,共6页Journal of Modern Urology

基　　金：江苏省科教能力提升工程项目(No.ZDXK202219)。

摘　　要：目的 比较经腹膜后途径机器人辅助腹腔镜下肾部分切除术治疗腹侧和背侧肾肿瘤的疗效。方法 回顾性分析2021年1月—2024年2月南京医科大学第一附属医院收治的131例行经腹膜后途径机器人辅助腹腔镜下肾部分切除术的肾肿瘤患者的临床资料。根据术前影像资料将患者分为腹侧肾肿瘤组(n=35)和背侧肾肿瘤组(n=96),对比两组患者的围手术期及预后情况。结果 131例患者手术均顺利完成,无中转开放或腹腔脏器损伤者。腹侧和背侧组患者在热缺血时间[中位数(四分位间距,IQR):20(IQR:16.75)min vs.22(IQR:15.25)min]、中位手术时间[57.0(IQR:29.5)min vs.58.5(IQR:39.75)min]、中位术中估计失血量[50(IQR:80)mL vs.50(IQR:80)mL]、中位术中输血率(0 vs. 2.1%)、术中加用第四手术机械臂的患者比例(42.9%vs. 37.5%)、手术前后血红蛋白(Hb)变化值[(-12.9±9.0)g/L vs.(-11.5±9.4)g/L]和估算肾小球滤过率(eGFR)变化值[(-3.8±12.4)mL/min vs.(-7.0±13.6)mL/min]、术后中位住院时间[4(IQR:0)d vs. 4(IQR:2)d]以及达到肾部分切除术后“三连胜”标准的患者比例(94.3%vs. 86.5%)等方面差异均无统计学意义(P>0.05)。患者的中位随访时间为9.8(5.5,24.0)个月,无死亡病例。除1例背侧肾肿瘤患者术后1年出现骨转移外均无复发转移。结论 对于腹侧和背侧肾肿瘤均可采用经腹膜后途径机器人辅助腹腔镜下肾部分切除术治疗,且手术效果相当。Objective To compare the efficacy of retroperitoneal robot-assisted laparoscopic partial nephrectomy(RALPN)in the treatment of ventral and dorsal renal tumor.Methods The clinical data of 131 patients with renal tumor who underwent retroperitoneal RALPN at our hospital during Jan.2021 and Feb.2024 were retrospectively analyzed.The patients were divided into the ventral renal tumor group(n=35)and dorsal renal tumor group(n=96)according to preoperative images.Perioperative outcomes and prognosis were compared between the two groups.Results All 131 surgeries were successfully completed without conversion to open surgery or abdominal organ injury.There were no significant differences in warm ischemia time[median(interquartile range,IQR):20(16.75)min vs.22(IQR:15.25)min],operation time[57.0(IQR:29.5)min vs.58.5(IQR:39.75)min],estimated intraoperative blood loss[50(IQR:80)mL vs.50(IQR:80)mL],proportion of patients with intraoperative blood transfusion(0 vs.2.1%),proportion of patients using four arms during operation(42.9%us.37.5%),postoperative reduction of hemoglobin(Hb)[(-12.9±9.0)g/L vs.(-11.5±9.4)g/L],reduction of estimated glomerular filtration rate(eGFR)[(-3.8±12.4)mL/min vs.(-7.0±13.6)mL/min],postoperative hospital stay[4(IQR:0)d vs.4(IQR:2)d],and proportion of meeting"Trifecta"criteria(94.3%vs.86.5%,P>0.05).During the median follow-up of 9.8(5.5,24.0)months,no death occurred,and no recurrence or metastasis were observed except that bone metastasis occurred in 1 patient in the dorsal renal tumor group.Conclusion Both ventral and dorsal renal tumors can be treated with retroperitoneal RALPN,and the surgical outcomes of both are comparable.

关 键 词：肾肿瘤 腹膜后 机器人 肾部分切除术 腹侧肿瘤 背侧肿瘤 

分 类 号：R692[医药卫生—泌尿科学]