摘要
目的探讨单一体位机器人辅助腹腔镜肝后下腔静脉癌栓取出术的可行性和安全性。方法回顾性分析2015年12月至2020年8月郑州大学第一附属医院收治的6例行单一体位机器人辅助腹腔镜肝后下腔静脉癌栓取出术患者的临床资料。男5例,女1例;平均年龄58(46~74)岁。平均体质指数24.6(20.6~28.2)kg/m2。肿瘤位于左侧2例,右侧4例;肿瘤直径平均9.6(7~13)cm。癌栓Mayo分级Ⅱ级4例,Ⅲ级2例。手术按"先切开取栓再切除肾脏"的策略以减少癌栓脱落,术中遵循"肾动脉离断后静脉优先"的技术路线,在单一体位下完成翻肝右叶,阻断第一肝门血管、下腔静脉两端及左肾静脉,将癌栓取出后缝合重建下腔静脉。分析围手术期指标及术后肿瘤控制情况。结果本组6例手术均顺利完成,平均手术时间210(130~320)min,平均失血量800(300~2100)ml,3例术中输血。术中下腔静脉平均阻断时间为21(15~43)min。术中出现1例下腔静脉近心端阻断不全,1例第一肝门阻断不全,均在出血状态下完成取栓术;1例术中发现侵犯下腔静脉,取出癌栓上段后将下腔静脉离断。术后重症监护病房住院时间平均2.1(1~4)d,引流时间平均5(4~9)d。术后出现肾功能不全3例,肝功能异常2例,经治疗后均恢复正常。术后病理检查示肾透明细胞癌5例,肾肉瘤1例,术后5例口服靶向药物辅助治疗。6例均获得随访,中位随访时间27(3~54)个月,3例无复发或转移,1例带瘤存活,2例因肿瘤转移死亡。结论单一体位机器人辅助腹腔镜肝后下腔静脉癌栓取出术具有操作简便、术中无需更改体位、节省手术时间、创伤小、恢复快、并发症发生率低的优点,是一种安全、可行的治疗肝后下腔静脉癌栓的方法。
Objective To explore the feasibility and safety of robot-assisted retrohepatic inferior vena cava(IVC)tumor thrombectomy for renal tumor patients with a single position.Methods The clinical data of 6 renal tumor patients with retrohepatic IVC thrombus(5 males and 1 female,mean age of 58 years)who underwent robot-assisted retrohepatic IVC tumor thrombectomy with a single position in First Affiliated Hospital of Zhengzhou University from December 2015 to August 2020 were retrospectively reviewed.Four cases had the renal tumor on the right side and two on the left side.The mean tumor size was 9.6 cm(range 7-13 cm).There were 4 cases of Mayo levelⅡand 2 cases of levelⅢIVC thrombus with the mean IVC thrombus length of 6.5 cm(range 5-8cm).The"IVC-first,kidney-last"robotic technique was developed to minimize chances of IVC thrombus embolization for retrohepatic IVC thrombus,and a"artery-first,vein-second"robotic operative strategy were developed to minimize chances of intraoperative hemorrhage.The whole procedure(the suprahepatic infradiaphramatic IVC,first porta hepatis and left renal vein control,caval exclusion,tumor thrombectomy,IVC repair,radical nephrectomy)was performed exclusively robotically with a single position.Results All 6 robotic procedures were successful,without open conversion or mortality.The mean operative time was 210 min(130-320 min),estimated blood loss was 800 ml(300-2100 ml)and three patients(5%)received intraoperative blood transfusion.The mean time of occlusion of IVC was 21 min(15-43min).Incomplete blocking occurred in two cases(one IVC,one first porta hepatis),and tumor thrombectomy were completed with intraoperative loss.IVC invasion was confirmed intraoperatively in one patient and we staple-transected the IVC without reconstruction.Six patients were all transferred to the intensive care unit for median of 2.1 days(1-4 days)after surgery.The mean time of postoperative drainage was 5 days(4-9 days).Renal dysfunction occurred in 3 patients and liver dysfunction occurred in 2 patients,and
作者
王声政
范雅峰
王健阁
刘俊肖
朱照伟
陶金
张雪培
Wang Shengzheng;Fan Yafeng;Wang Jiange;Liu Junxiao;Zhu Zhaowei;Tao Jin;Zhang Xuepei(Department of Urology,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450001,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2022年第1期23-27,共5页
Chinese Journal of Urology
关键词
肾肿瘤
癌栓
下腔静脉
机器人手术
血栓切除术
Kidney neoplasms
Tumor emboli
Inferior vena cava
Robotics
Thrombectomy
