临近集合系统肾肿瘤行腹膜后与经腹入路机器人辅助肾部分切除术的对比分析  

Comparative analysis between retroperitoneal and transperitoneal robot-assisted partial nephrectomy for renal tumors near the collection system

作　　者：程功 倪栋 邢毅飞[1,2] 王淼 肖亚军[1,2] 蒋国松 陈朝晖[1,2] 韩晓敏 梁华庚 章小平 CHENG Gong;NI Dong;XING Yifei;WANG Miao;XIAO Yajun;JIANG Guosong;CHEN Zhaohui;HAN Xiaomin;LIANG Huageng;ZHANG Xiaoping(Department of Urology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430022,China;Institute of Urologic Surgery,Tongji Medical College,Huazhong University of Science and Technology)

机构地区：[1]华中科技大学同济医学院附属协和医院泌尿外科,武汉430022 [2]华中科技大学同济医学院泌尿外科研究所

出　　处：《临床泌尿外科杂志》2024年第11期954-959,共6页Journal of Clinical Urology

基　　金：国家自然科学基金(No:82002704);武汉协和医院2023年毕业后教育教学改革项目基金(No:F015010042330603606)。

摘　　要：目的:对比分析临近集合系统的肾肿瘤采取不同机器人手术入路的临床疗效及安全性。方法:回顾性收集2020年1月-2023年1月在华中科技大学同济医学院附属协和医院行腹膜后机器人辅助肾部分切除术(retroperitoneal robot-assisted partial nephrectomy,R-RAPN)和经腹入路机器人辅助肾部分切除术(transperitoneal robot-assisted partial nephrectomy,T-RAPN)的54例患者资料。分别记录R-RAPN组及T-RAPN组患者的手术时间、术中失血量、输血量、缝合方式、肾脏热缺血时间、有无转入ICU、术后拔出引流管时间、出院时间、并发症及处理措施;术前术后血红蛋白、肌酐、尿素氮、肾小球滤过率的变化,肿瘤病理分级及类型、切缘阳性率等。对围手术期及随访指标进行统计分析。结果:T-RAPN组中位手术时间为113.5(83.0,150.0)min,R-RAPN组中位手术时间为87.5(58.0,101.5)min,差异有统计学意义(P=0.0392)。T-RAPN组中位热缺血时间为27.0(20.0,35.0)min,R-RAPN组中位热缺血时间为20.0(16.5,25.5)min,差异无统计学意义。T-RAPN组中位失血量为100.0(50.0,200.0)mL,R-RAPN组中位失血量为50.0(30.0,75.0)mL,差异无统计学意义。2组所有患者均未转入ICU。T-RAPN组患者中位拔引流管时间6.5(4.0,7.0)d,术后中位出院时间7.0(5.0,7.0)d;R-RAPN组中位拔引流管时间5.0(4.0,5.0)d,术后中位出院时间6.0(5.0,6.0)d,差异无统计学意义。所有患者术后标本均无切缘阳性,终末随访肾功能与术前几乎一致。R-RAPN组患者平均随访(24.6±2.1)个月,无一例局部复发或远处转移。T-RAPN组患者平均随访(31.9±7.3)个月,有1例局部复发。结论:临近集合系统机器人辅助肾部分切除术入路的选择可根据肿瘤偏向针对性地采用腹膜后或经腹途径。对于复杂的肾肿瘤,推荐T-RAPN以获得更大的操作空间和更广阔的视野。无论采取哪种入路方式,RAPN均能在获得良好预后的同时,能最大程度地保护肾功能。Objective To comparatively analyze the clinical efficacy and safety of different surgical approaches for renal tumors near the collection system.Methods We have retrieved the data of patients undergoing retroperitoneal robot-assisted partial nephrectomy(R-RAPN) and transperitoneal robot-assisted partial nephrectomy (T-RAPN) approaches at Wuhan Union Hospital from January 2020 to January 2023. The operating time, intraoperative blood loss, blood transfusion volume, suture method, renal warm ischemia time, transferring to ICU or not, postoperative drainage tube withdrawal time, discharge time, complications and treatment measures were recorded in the R-RAPN group and the T-RAPN group respectively. Changes in hemoglobin, creatinine, urea nitrogen, and glomerular filtration rate before and after surgery, tumor pathological grade and type, positive rate of surgical margin, etc. were also observed. Statistical analysis was performed on perioperative and follow-up characteristics.Results The median operation time in the T-RAPN group was 113.5(83.0, 150) minutes and that in the R-RAPN group was 87.5(58.0, 101.5) minutes, with a statistical difference between the groups(P=0.039 2). The median warm ischemia time was 27.0(20.0, 35.0) minutes in the T-RAPN group and 20.0(16.5, 25.5) minutes in the R-RAPN group. There was no statistical difference between the groups. The median blood loss in the T-RAPN group was 100.0(50.0, 200.0) mL and that in the R-RAPN group was 50.0(30.0, 75.0) mL. There was no statistical difference between the groups. None of the patients in both groups were transferred to ICU. The median time for removing the drainage tube was 6.5(4.0, 7.0) days and the postoperative discharge time was 7.0(5.0, 7.0) days in the T-RAPN group. The median time for removing the drainage tube was 5.0(4.0, 5.0) days and the discharge time was 6.0(5.0, 6.0) days in the R-RAPN group. There was no statistical difference between the two groups. No surgical margin was positive in all patients' specimens after surgery, and the re

关 键 词：肾癌 临近集合系统 机器人 肾部分切除术 腹膜后 经腹 

分 类 号：R737.11[医药卫生—肿瘤]