肝尾状叶切除在机器人辅助腹腔镜下腔静脉癌栓切除术中的应用:单中心经验  

Hepatic caudate lobectomy in robot-assisted inferior vena cava tumor thrombectomy:single-center experience

作　　者：彭程[1] 宋佳龙 赵国栋[3] 刘侃[1] 许亮[1] 贾卓 李智[1] 李小航 李世超[1] 王保军[1] 张旭[1] 马鑫[1] 黄庆波[1] Peng Cheng;Song Jialong;Zhao Guodong;Liu Kan;Xu Liang;Jia Zhuo;Li Zhi;Li Xiaohang;Li Shichao;Wang Baojun;Zhang Xu;Ma Xin;Huang Qingbo(Senior Department of Urology,the Third Medical Center of PLA General Hospital,Beijing 100039,China;School of Medicine,Nankai University,Tianjin 300071,China;Senior Department of Hepato-Pancreato-Biliary Surgery,the First Medical Center of PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第三医学中心泌尿外科医学部,北京100039 [2]南开大学医学院,天津300071 [3]解放军总医院第一医学中心肝胆胰外科医学部,北京100853

出　　处：《微创泌尿外科杂志》2024年第4期229-234,共6页Journal of Minimally Invasive Urology

基　　金：国家自然科学基金面上项目(82273412)。

摘　　要：目的:探讨机器人辅助腹腔镜下腔静脉癌栓切除术联合肝尾状叶切除术治疗301Ⅱ~Ⅲ级下腔静脉癌栓的可行性和有效性。方法:回顾性分析2021年1月至2022年6月于解放军总医院第一医学中心行机器人辅助腹腔镜下腔静脉癌栓切除术的5例患者的临床资料,所有患者术中均联合部分肝尾状叶切除以显露肝后段下腔静脉。其中男性2例,女性3例,中位年龄61(60~75)岁;中位体质量指数24.8(21.7~25.3)kg/m2。根据301分级,Ⅱ级癌栓患者1例,Ⅲ级癌栓患者4例。下腔静脉癌栓中位高度10.8(10.4~13.1)cm,癌栓中位最大径2.0(1.5~3.9)cm。结果:5例患者手术均顺利完成,无中转开放。中位手术时间510(290~795)m i n,中位失血量1500(900~2000)ml。患者术后中位重症监护室(intensive care unit,ICU)住院时间4(0~7)d,中位总住院时间11(6~13)d。术后出现Ⅰ级并发症2例,Ⅱ级并发症3例,无围术期死亡病例。出院时该5例患者的肝、肾功能均降至基线水平。中位随访时间8.3(2.5~16.1)个月,无肿瘤复发、进展、转移等情况。结论:对于肾肿瘤伴高度毗邻第二肝门的粗大下腔静脉癌栓的患者,术中切除肝尾状叶能够更好地显露肝后段下腔静脉,有利于术中尽早控制癌栓近心端下腔静脉,从而提高手术的安全性。Objective:To explore the feasibility and effectiveness of robot-assisted inferior vena cava tumor thrombectomy combined with hepatic caudate lobectomy for patients with levelⅡ-Ⅲ(301 classification)inferior vena cava tumor thrombus.Methods:The clinical data of 5 patients who underwent robot-assisted inferior vena cava tumor thrombectomy in the First Medical Center of PLA General Hospital from January 2021 to June 2022 were retrospectively analyzed.All of the 5 patients underwent partial hepatic caudate lobectomy during the surgeries to expose the retrohepatic inferior vena cava.There were 2 males and 3 females with a median age of 61(60-75)years,the median body mass index was 24.8(21.7-25.3)kg/m2.According to 301 classification,there were 1 patient with levelⅡtumor thrombus,and 4 patients with levelⅢtumor thrombus.The median height of inferior vena cava tumor thrombus was 10.8(10.4-13.1)cm,and the maximum median diameter of tumor thrombus was 2.0(1.5-3.9)cm.Results:All the 5 operations were successfully completed without conversion.The median operative time was 510(290-795)min,and the median estimated blood loss was 1500(900-2000)ml.The median length of postoperative intensive care unit(ICU)stay was 4(0-7)d,and the median postoperative hospital stay was 11(6-13)d.There were 2 cases of gradeⅠcomplications,3 cases of gradeⅡcomplications,and no perioperative death.At the time of discharge,the liver and kidney function of the 5 patients had decreased to the baseline level.The median follow-up time was 8.3(2.5-16.1)months,and there was no tumor recurrence,progression,or metastasis.Conclusion:For patients with renal tumors accompanied by large inferior vena cava tumor thrombi closely adjacent to the second hepatic hilum,intraoperative resection of the caudate lobe allows better exposure of the retrohepatic segment of the inferior vena cava,facilitating early intraoperative control of the proximal end of the inferior vena cava tumor thrombus and thereby improving surgical safety.

关 键 词：肾肿瘤 下腔静脉癌栓 肝尾状叶 机器人 腹腔镜 

分 类 号：R737.11[医药卫生—肿瘤]