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)对巨大肾血管平滑肌脂肪瘤(RAML)的疗效。方法回顾性分析浙江省人民医院2014年10月至2020年5月行手术治疗的43例巨大RAML(直径>7cm)患者的临床资料,其中23例行RAPN,20例行LPN。RAPN组男4例,女19例;中位年龄45(17~65)岁;体质指数中位数20.3(18.0~25.7)kg/m^(2);肿瘤位于左侧11例,右侧12例;上极9例,中极5例,下极5例;多发肿瘤4例,其中1例为双侧,3例为单侧;R.E.N.A.L.评分中位数8(4~12)分,瘤体最大径中位数7.5(7.1~17.0)cm。LPN组男1例,女19例;中位年龄53(27~78)岁;体质指数中位数21.4(19.0~25.5)kg/m^(2);肿瘤位于左侧9例,右侧11例;上极7例,中极4例,下极5例;多发肿瘤4例,其中2例为双侧,2例为单侧;R.E.N.A.L.评分中位数8(4~12)分,瘤体最大径中位数7.3(7.0~20.0)cm。两组一般资料的比较差异均无统计学意义(P>0.05)。比较两组患者的手术时间、热缺血时间、术中出血量、术后并发症、肾功能等指标变化,以及随访结果。结果两组手术均顺利完成,均未中转开放手术。RAPN组和LPN组手术时间[115(90~220)min与145(120~240)min]、热缺血时间[15(10~25)min与23(20~28)min]差异均有统计学意义(P<0.05)。两组患者术后进食时间[1(1~2)d与1(1~3)d]、拔管时间[4(3~16)d与5(3~14)d]、术后绝对卧床时间[4(3~7)d与4(2~12)d]、住院时间[7(5~16)d与8(4~14)d]以及手术前后肌酐差值[11.3(1.6~44.8)μmol/L与18.2(1.0~54.8)μmol/L]、eGFR差值[21.5(1.8~43.5)ml/(min·1.73m^(2))与22.1(5.6~51.3)ml/(min·1.73m^(2))]、血红蛋白差值[22.5(11~43)g/L与23.0(9~62)g/L],差异均无统计学意义(P>0.05)。RAPN组和LPN组的术后并发症发生率分别为0和15%(3/20),差异有统计学意义(P<0.05)。LPN组中3例输血,其中2例为肾脏创面出血,术中行超声刀电凝止血及止血棉填塞,缝合后好转;1例为术后第2天肾脏创面动脉活动性出血,行输血及栓塞治疗后好转。2例术后�
Objective To evaluate the efficacy of robot-assisted partial nephrectomy(RAPN)and laparoscopic partial nephrectomy(LPN)in the treatment of giant(>7cm)renal angiomyolipoma(RAML).Methods The clinical data of 43 patients with giant RAML(>7cm)who underwent surgery in Zhejiang People's Hospital from October 2014 to May 2020 was retrospectively analysed,including 23 routine RAPN and 20 routine LPN.The median age of patients in the RAPN group was 45(17-65)years old,with 4 males and 19 females.The median body mass index(BMI)was 20.3(18.0-25.7)kg/m^(2).Tumors located on the left side in 11 cases and on the right side in 12 cases.Tumors located on upper pole in 9 cases,middle pole in 5 cases,lower pole in 5 cases.The median R.E.N.A.L.score was 8(4-12)points and the largest tumor diameter was 7.5(7.1-17.0)cm.The median age of patients in the LPN group was 53(27-78)years old,with 1 males and 19 females.The median BMI was 21.4(19.0-25.5)kg/m^(2).Tumors located on the left side in 9 cases and right side in 11 cases.Tumors located on the upper pole in 7 cases,middle pole in 4 cases and lower pole in 5 cases.4 cases were multiple tumors,2 cases were bilateral,and 2 cases were unilateral.The median R.E.N.A.L.score was 8(4-12)points and the median maximum diameter of tumor was 7.3(7.0-20.0)cm.There was no statistically significant difference in general information between the two groups(P>0.05).The operation time,warm ischemia time,intraoperative blood loss,postoperative complications,postoperative recovery,renal function and other indicators of the two groups were compared,as well as the follow-up results.Results The operations in both groups were successfully completed,and none of them were transferred to open surgery.Patients in the RAPN group had markedly lower median operation time[115(90-220)vs.145(120-240)min],and reduced median time of warm ischemia[15(10-25)vs.23(20-28)min]than those in the LPN group,the difference between the two groups was statistically significant(P<0.05).There were no significant differences in the me
作者
韦飞
陈心朋
王帅
张大宏
Wei Fei;Chen Xinpeng;Wang Shuai;Zhang Dahong(Department of Urology,Zhejiang Provincial People’s Hospital,Hangzhou 310000,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2022年第1期5-9,共5页
Chinese Journal of Urology
