达芬奇机器人孤立肾肾肿瘤的个性化保肾手术策略  

Personalized nephron-sparing surgical strategy for solitary kidney tumor by Da Vinci robot

作　　者：叶剑青 李霖 陈少军 潘秀武 王磊[1] 干思舜 曲发军 褚健 张良[1] 崔心刚 YE Jianqing;LI Lin;CHEN Shaojun;PAN Xiuwu;WANG Lei;GAN Sishun;QU Fajun;CHU Jian;ZHANG Liang;CUI Xingang(Department of Urology,Xinhua Hospital Affiliated to Medical College of Shanghai Jiao Tong University;Department of Urology,Third Affiliated Hospital of the Second Military Medical University)

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 [2]海军军医大学第三附属医院泌尿外科

出　　处：《临床泌尿外科杂志》2025年第1期47-52,共6页Journal of Clinical Urology

基　　金：上海交通大学医学院附属新华医院院级临床研究项目(No:21XHDB06)。

摘　　要：目的:探讨达芬奇机器人辅助腹腔镜下孤立肾肾肿瘤个性化保肾手术策略的选择。方法:对2022年6月—2024年11月在上海交通大学医学院附属新华医院接受达芬奇机器人辅助腹腔镜肾部分切除术的14例孤立肾肾肿瘤患者的临床资料进行回顾性分析。其中,男6例,女8例;年龄38~83岁,平均63岁。在11例单发肿瘤患者中,肿瘤直径1.1~6.8cm,平均2.8cm;3例多发肿瘤患者中,肿瘤直径0.8~3.8cm,平均2.1 cm。完全内生性肿瘤1例,肾门部肿瘤2例。R.E.N.A.L.评分4~9分,平均7.3分。术前根据R.E.N.A.L.评分、肿瘤个数、是否完全内生、是否肾门部、术前肌酐等指标,将患者分为低难度组、中等难度组及高难度组。不同组采用不同的个性化保肾手术策略。记录手术时间、热缺血时间、手术入路、肾动脉阻断方式、缝合方法、肾脏降温方式以及术后肌酐变化等指标。结果:所有14例患者均成功完成达芬奇机器人保肾手术,无中转开放。术前肌酐75~157μmol/L,平均99.4μmol/L;热缺血时间8~58min,平均25.4min。术后24h肌酐75~334μmol/L,平均161.6μmol/L。所有患者术后24h肌酐均有所上升,但在7d的观察中未发现进行性肾功能损伤。结论:针对不同复杂程度的孤立肾肾肿瘤,术前可按难易度分组,分别采用不同手术策略进行机器人保肾手术。此方法安全、有效,不仅能更有效保护肾功能,且能简化手术步骤、提高手术效率,对于孤立肾肾肿瘤保肾手术策略的制定具有一定指导意义。Objective:To explore the selection of personalized nephron-sparing surgical strategy for solitary kidney tumor by Da Vinci robot-assisted laparoscopy.Methods:We retrospectively analyzed the clinical data of 14 solitary kidney patients with renal tumors who underwent Da Vinci robot-assisted laparoscopic partial nephrectomy at Xinhua Hospital Affiliated to Medical College of Shanghai Jiao Tong University between June 2022 and November 2024.Among them,6 cases were male and 8 cases were female.The average age was 63 years,ranged from 38-83 years.In 11 patients with a single tumor,tumor diameter ranged from 1.1 to 6.8 cm,with an average diameter of 2.8 cm.In 3 patients with multiple tumors,the maximum tumor diameter was 3.8 cm and the minimum tumor diameter was 0.8 cm,with an average diameter of 2.1 cm.One case was completely endogenous renal tumor and two cases were tumors of renal hilum.The R.E.N.A.L.score was 4-9,with an average score of 7.3.All 14 patients were divided into low difficulty group,medium difficulty group and high difficulty group according to R.E.N.A.L.score,number of tumors,complete endogeneity tumor or not,tumor of renal hilum or not,preoperative creatinine.Different personalized nephron-sparing surgical strategies were applied in different groups.We recorded clinical data such as operative time,warm ischemia time,surgical approach,renal artery blocking mode,suturing method,renal cooling mode and postoperative creatinine changes.Results:All 14 patients underwent Da Vinci robot-assisted partial nephrectomy successfully without conversion to open operation.Preoperative creatinine levels were 75-157μmol/L,with an average of 99.4μmol/L.The warm ischemia time was 8-58 minutes,with an average of 25.4 minutes.Postoperative creatinine levels at 24 hours were 75-334μmol/L,with an average of 161.6μmol/L.All patients had an increase in creatinine levels at 24 hours,but no progressive renal function damage was observed during the 7-day follow-up.Conclusion:For solitary kidney tumors with different complexi

关 键 词：孤立肾 肾肿瘤 机器人 保肾手术 

分 类 号：R737.11[医药卫生—肿瘤]