机器人辅助腹腔镜与腹腔镜肾部分切除术治疗儿童肾肿瘤的疗效比较  

Comparison of therapeutic effects between robot assisted laparoscopic and laparoscopic partial nephrectomy forpediatric renal tumors

作　　者：董克勤 潘秀武 陈少军 叶剑青 张良[1] 崔心刚 Dong Keqin;Pan Xiuwu;Chen Shaojun;Ye Jianqing;Zhang Liang;Cui Xingang(Department of Urology,School of Medicine,Xinhua Hospital Affiliated to Shanghai Jiao Tong University,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院泌尿外科,上海200092

出　　处：《中华泌尿外科杂志》2024年第10期740-744,共5页Chinese Journal of Urology

摘　　要：目的比较机器人辅助腹腔镜肾部分切除术(RAPN)与腹腔镜肾部分切除术(LPN)治疗儿童肾肿瘤的疗效。方法回顾性分析2019年3月至2024年3月上海交通大学医学院附属新华医院收治的29例肾肿瘤患儿的临床资料。RAPN组10例,男6例,女4例;中位年龄7.5(4,12)岁;肿瘤直径(4.3±1.6)cm,中位R.E.N.A.L.评分9(8,11)分,肿瘤相对大小(肿瘤体积/健侧肾脏体积)(34.0%±19.3%)。LPN组19例,男8例,女11例;中位年龄5.0(4,10)岁;肿瘤直径(4.4±1.6)cm,中位R.E.N.A.L.评分9(8,11)分,肿瘤相对大小(37.7%±18.1%)。两组术前一般资料比较差异均无统计学意义(P>0.05)。两组均行肾部分切除术,肾动脉阻断方式均为热缺血。比较两组术中和术后临床资料,使用简单线性回归分析肿瘤相对大小与术中热缺血时间的相关性。结果本研究29例手术均顺利完成,RAPN组和LPN组的手术时间分别为(115.0±28.4)min和(127.9±28.2)min(P=0.25);热缺血时间分别为(20.9±3.0)min和(27.0±4.5)min(P<0.01);术中出血量分别为(50.0±24.5)ml和(80.0±21.2)ml(P<0.01);手术前后血红蛋白差值分别为(10.3±3.5)g/L和(12.9±2.7)g/L(P<0.05);术后中位引流管放置时间分别为3.5(3,4)d和4.0(3,6)d(P=0.17);术后中位住院时间分别为4.5(4,8)d和6.0(5,10)d(P<0.05)。术后病理结果,RAPN组肾母细胞瘤3例、MiT家族异位相关肾细胞癌3例、混合性上皮间质肿瘤2例、囊性肾瘤2例;LPN组肾母细胞瘤10例、畸胎瘤3例、MiT家族异位相关肾细胞癌2例、后肾腺瘤2例、未分类的肾细胞癌1例、囊性肾瘤1例。除LPN组1例术后出现39℃以上高热,其余患儿术中和术后无严重并发症。与术前相比,术后1个月复查估算肾小球滤过率(eCFR),RAPN组和LPN组分别下降(8.9±18.9)ml/(min·1.73m^(2))和(21.4±34.8)ml/(min·1.73m^(2)),差异无统计学意义(P=0.36);术后3个月复查eGFRRAPN组和LPN组分别下降(5.9±23.4)ml/(min·1.73m^(2))和(13.9±20.1)ml/(min·1.73m^(2)),差异无统计学意义(P=Objective To compare the efficacy of robot assisted laparoscopic partial nephrectomy(RAPN)and laparoscopic partial nephrectomy(LPN)in the treatment of pediatric renal tumors.Methods A retrospective analysis was conducted on the clinical data of 29 children with renal tumors admitted to Xinhua Hospital from March 2019 to March 2024.Among them,there were 10 cases in the RAPN group,including 6 males and 4 females;The median age is 7.5(4,12)years old,with a tumor diameter of(4.3±1.6)cm,a median R.E.N.A.L.score of 9(8,11),and relative tumor size(tumor volume/contralateral kidney volume)of(34.0%±19.3%).There were 19 cases in the LPN group,8 males and 11 females;the median age is 5.0(4,11)years old,with a tumor diameter of(4.4±1.6)cm,a median R.E.N.A.L.score of 9(8,11),and relative tumor size(37.7%±18.1%).There was no statistically significant difference in preoperative characteristics between the two groups(P>0.05).Both groups underwent partial nephrectomy,with renal artery occlusion and then warm ischemia.Clinical data from both groups during and postoperatively were compared,and a simple linear regression analysis was utilized to assess the correlation between the relative size of the tumor and the duration of intraoperative warm ischemia.Results All 29 cases underwent a successful surgery.Compared with the LPN group,the total surgery time in the RAPN group was(115.0±28.4)minutes versus(127.9±28.2)min(P=0.25);the warm ischemia time was(20.9±3.0)min versus(27.0±4.5)min,respectively(P<0.01);the intraoperative bleeding was(50.0±24.5)ml and(80.0±21.2)ml(P<0.01);the difference in hemoglobin level before and after surgery was(10.3±3.5)g/L versus(12.9±2.7)g/L(P<0.05),respectively;the median postoperative drainage time was 3.5(3,4)days versus 4.0(3,6)days(P=0.17);the median postoperative hospital stay was 4.5(4,8)days versus 6.0(5,10)days(P<0.05).There were 3 cases of renal cell carcinoma associated with the MiT family translocation,2 cases of mixed epithelial and stromal tumors,and 2 cases of cystic nephroma by

关 键 词：肾切除术 儿科 肾肿瘤 机器人手术 腹腔镜 

分 类 号：R737.11[医药卫生—肿瘤]