摘要
目的:探讨机器人辅助腹腔镜下肾部分切除术(robot-assisted laparoscopic partial nephrectomy,RAPN)的安全性与有效性。方法:回顾性分析2015年5月~2016年9月22例行RAPN患者的临床资料。男10例,女12例。年龄27~72岁,平均(47.6±12.5)岁。肾肿瘤位于左侧11例,右侧11例。肿瘤最大径2.3~12.8cm,平均(4.0±2.2)cm。复杂性肾肿瘤9例,其中完全内生型肿瘤1例,大肿瘤(直径>7cm)4例,肾门部肿瘤4例。结果:经腹入路20例,经腹膜后入路2例。22例均获成功,无中转开放。手术时间90~420min,平均(191.6±69.9)min;术中失血量10~800ml,平均(180.2±250.0)ml;热缺血时间(warm ischemia time,WIT)9~30min,平均(24.4±9.3)min。术后留置引流管2~7d,平均(4.2±1.4)d;术后住院时间5~14d,平均(8.5±1.9)d。术前肌酐(80.0±23.4)μmol/L,术后肌酐(81.2±31.3)μmol/L。术后病理:肾透明细胞癌11例,肾错构瘤7例,乳头状肾细胞癌2例,多房囊性肾细胞癌1例,嫌色细胞癌1例;无切缘阳性。术后出血1例,行剖腹探查,缝合止血后痊愈。随访4~20个月,无局部复发、转移和死亡发生。结论:RAPN安全有效,在肾肿瘤的完整切除和创面缝合上有明显的优势,尤其在处理复杂肾肿瘤中优势明显。
Objective： To investigate the safety and efficacy of robot-assisted laparoscopic partial nephrectomy （RAPN）. Method： We retrospectively analysed the clinical data of 22 patients who underwent RAPN from May 2015 to September 2016 in our department. There were 10 males and 12 females. The mean age was （47. 6 2. 12.5） years old （range, 27-72）. There were 11 tumors in the left kidney and 11 in the right. The maximal diame- ter of tumor was from 2.3 to 12.8 cm, with an average of （4.0± 2.2） cm. There were nine complex renal tumors, including one complete endogenous tumor, four large tumors （〉7 cm in diameter） and four hilar tumors. Result： Twenty cases were carried out via transperitoneal approach and two cases via retroperitoneal approach. All the operations were accomplished successfully without conversion to open surgery. The mean operative time was （191.6±69.9） min（range, 90-420）. The mean blood loss was （180.2±250.0） ml （range, 10-800）. The warm ischemia time （WIT） was 9-30 min, with an average of （24.42± 9.3） rain. The drainage tubes were removed in （4.2±1. 4） days （range, 2-7 ） and the mean postoperative hospital stay was （8.5±1.9） days （range, 5-14）. The mean preoperative and postoperative serum creatinine was （80.02-23.4） μmol/L and （81.2±31.3） /lmol/L re- spectively. Pathology revealed 11 cases were clear renal cell carcinoma, 7 were renal angiomyolipoma, 2 were pa- pillary renal cell carcinoma, 1 was multilocular cystic renal cell carcinoma and 1 was chromophobe renal cell carci- noma. No positive margins were seen. One case experienced postoperative bleeding and underwent exploratory laparotomy and hemostasis was done with re-suture. No local recurrence, metastasis or death was found over fol- low-up period of 4-20 months. Conclusion： RAPN is a safe and feasible surgery in complete resection of the renal tumor and the reconstruction of the kidney, especially for some complex renal tumors.
出处
《临床泌尿外科杂志》
2017年第5期335-338,343,共5页
Journal of Clinical Urology
