俯卧位机器人辅助腹腔镜腹膜后肿瘤切除术的可行性和安全性  

The feasibility and safety of robot-assisted laparoscopic retroperitoneal tumor resection in prone position

作　　者：陈浩楠 杨潇[1] 柏荣杰 庄俊涛 蔡令凯 刘沛昆 曹强[1] 李鹏超[1] 吕强[1] Chen Haonan;Yang Xiao;Bai Rongjie;Zhuang Juntao;Cai Lingkai;Liu Peikun;Cao Qiang;Li Pengchao;Lyu Qiang(Department of Urology,First Affiliated Hospital of Nanjing Medical University(Jiangsu Province Hospital),Nanjing 210029,China;Department of Urology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,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,南京210029 [2]华中科技大学同济医学院附属同济医院泌尿外科,武汉430030

出　　处：《中华泌尿外科杂志》2024年第8期577-581,共5页Chinese Journal of Urology

基　　金：江苏省科教能力提升工程(ZDXK202219)。

摘　　要：目的探讨俯卧位机器人辅助腹腔镜腹膜后肿瘤切除术的可行性和安全性。方法回顾性分析2023年8月至2024年1月南京医科大学第一附属医院收治的8例腹膜后肿瘤患者的病例资料,男2例,女6例。年龄(47.4±12.5)岁。体质量指数(24.4±3.5)kg/m^(2)。美国麻醉医师协会分级Ⅱ(Ⅱ,Ⅲ)级。术前CT或MRI检查提示为腹膜后肿瘤,其中左侧肾上腺肿瘤4例,右侧肾上腺肿瘤2例,左侧非肾上腺肿瘤2例。术前诊断肾上腺无功能性肿瘤2例,嗜铬细胞瘤2例,库欣综合征1例,转移性肾细胞癌1例,非肾上腺肿瘤2例。所有患者均接受机器人辅助腹腔镜腹膜后肿瘤切除术。患者取俯卧位。通过两侧嗜最高点连线确定第4腰椎(L4)下缘,然后依次确定L1~L3下缘位置,以脊柱后正中线和腋中线为边界,将手术区域分为3等份。内侧分隔线约位于竖脊肌外侧缘,外侧分隔线约跨过第12肋尖端。在L2和L3之间的外侧分隔线上做长约3cm纵行切口放置观察镜套管,以自制气囊扩张腹膜外间隙,在手指引导下分别于内侧分隔线和腋中线处置人2个8mm套管作为操作孔。在髂平面上方置人1个或2个12mm套管作为辅助孔。术中游离腹膜外脂肪,打开Gerota筋膜。对于非肾上腺的腹膜后肿瘤,悬吊固定肿瘤周围大血管,用钛夹或Hem-o-lok夹闭离断细小动静脉,分离并完整切除肿瘤;对于肾上腺肿瘤,游离肾上极周围脂肪囊,显露肾上腺组织,将与肿瘤连接的肾上腺用Hem-o-lok夹闭后离断,沿肿瘤包膜周围分离并切除肿瘤。如行肾上腺全切术,则夹闭并离断肾上腺中央静脉,将肾上腺周围逐步解剖,直到完整切除肾上腺。记录体位摆放时间、建立套管时间、手术时间、术中出血量、术后并发症情况、术后住院时间、术后引流管拔除时间等和复发转移情况。手术时间定义为从机械臂开始操作到完整切除肿瘤的时间,2例因合并肾癌同时行肾部分切除术Objective To discuss the feasibility and safety of robot-assisted laparoscopic retroperitoneal tumor resection in prone position.Methods From August 2023 to January 2024,a total of eight patients with retroperitoneal tumors from the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed,including two males and six females.The average age was(47.4±12.5)years,average BMI was(24.4±3.5)kg/m^(2) and median ASA grade was 2(2,3).Retroperitoneal tumors were identified preoperatively through CT or MRI.The imaging revealed 4 cases of adrenal tumors located on the left side,2 on the right side,and 2 non-adrenal tumors situated on the left side.The preoperative diagnoses included 2 cases of non-functional adrenal tumors,2 cases of pheochromocytoma,1 case of Cushing's syndrome,1 case of metastatic renal cell carcinoma,and 2 cases of non-adrenal tumors.Robot-assisted laparoscopic retroperitoneal tumor resection was performed with all patients in prone position.The inferior margin of the fourth lumbar vertebra(L4)was determined by the line connecting the highest points of the iliac crests bilaterally.Subsequently,the inferior margins of the L1-L3 vertebrae were sequentially identified.The surgical field was then divided into three equal segments,utilizing the posterior midline of the spine and the midaxillary line as boundaries.The medial division was situated approximately at the lateral border of the vertical spinal muscles,while the lateral division was placed near the tip of the 12th rib.A longitudinal incision of approximately 3 cm in length was created within the lateral division between L2 and L3 for the insertion of a camera trocar.The extraperitoneal space was subsequently dilated using a self-made balloon,and two 8 mm trocars were placed as operative ports along the medial division and the midaxillary line,respectively,under finger guidance.Assistance trocars,one or two 12 mm in diameter,were introduced above the level of the iliac crest.During the operation,the extraperitoneal adipose

关 键 词：腹膜后肿瘤 俯卧位 机器人 

分 类 号：R735.4[医药卫生—肿瘤]