摘要
目的:探讨机器人辅助腹腔镜肾门部肿瘤手术治疗的技术优化及临床效果。方法:回顾分析我院2013年1月~2017年2月采用机器人辅助腹腔镜肾部分切除术(RALPN)治疗249例肾肿瘤患者的临床资料。其中肾门部肿瘤48例:左肾肿瘤26例,右肾肿瘤21例,双肾肿瘤1例(右侧肾门肿瘤,左肾多发肿瘤)。25例位于肾门前唇、19例位于后唇,完全内生型4例。结果:48例患者均成功完成机器人辅助腹腔镜肾部分切除术,无中转开放及大血管损伤者。平均手术时间125(65~225)min,其中经后腹腔途径19例,经腹腔途径29例,术中行肾盂修补26例。肾动脉平均阻断时间为22(14~53)min,术中平均出血量87(50~550)ml。病理回报:透明细胞癌36例,乳头状肾癌3例,血管平滑肌脂肪瘤5例,嗜酸细胞瘤2例,囊性肾细胞肿瘤2例。术后无漏尿及切缘阳性病例。随访28(3~46)个月,无局部复发及转移病例。结论:机器人辅助腹腔镜肾部分切除术治疗肾门部肿瘤手术精细,在肿瘤控制及安全性方面优势明显,通过合理的技术优化,可以明显降低手术难度。
Objective：To investigate the technical optimization methods and clinical result of robot-assisted laparoscopic partial nephrectomy for renal hilar tumors.Method：The clinical data of 249 cases receiving robot-assisted laparoscopic partial nephrectomy（RALPN）by Xijing Hospital from 2013 to 2017 were retrospectively reviewed.There were 48 cases of renal hilar tumors,including 26 cases of left renal tumors,21 cases of right renal tumors and 1 case of bilateral renal tumors.The tumors were located on the front lip in 25 cases and the rear lip in 19 cases,and there were 4 cases of complete endophytic renal tumors.Result：All procedures were completed successfully.The mean operation time was 125（range,65-225）min,the mean ischemia time was 22（range,14-53）min,and the mean estimated blood loss was 87（range,50-550）ml.There were 19 cases with retroperitoneal approach,29 cases through abdominal route,without open transit or large vessel injury.Twenty-six cases of renal pelvis repair were performed during the operation.Pathologically,there were 36 cases of clear cell renal cell carcinoma,3 cases of papillary renal cell carcinoma,5 cases of angioleiomyolipoma,2 case of cystic renal cell carcinoma and 2 case of oncocytoma.No positive surgical margin or urine leakage was observed.All patients had no local recurrence or distant metastasis during a mean follow-up period of 28（range,3-46）months.Conclusion：Robot-assisted laparoscopic partial nephrectomy is a fine technique for renal hilar tumor,and has obvious advantages in tumor control and safety.Through reasonable technical optimization,the operation difficulty is obviously reduced.
出处
《临床泌尿外科杂志》
2017年第10期789-792,共4页
Journal of Clinical Urology
关键词
肾门部肿瘤
机器人
肾部分切除术
renal hilar tumor
robotic surgery system
partial nephrectomy
