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)治疗孤立肾肾肿瘤的效果,并分析患者术后肾功能和远期生存的影响因素。方法回顾性分析2010年11月至2022年1月在解放军总医院行手术治疗的67例孤立肾肾肿瘤患者的临床资料。男48例,女19例;年龄(58.6±10.1)岁。按照手术方式不同分为RAPN组(43例)和LPN组(24例)。RAPN组较LPN组的R.E.N.A.L.评分更高[(8.7±1.5)分与(7.9±1.7)分,P=0.042],两组年龄[(57.4±10.2)岁与(60.9±9.8)岁,P=0.185]、体质量指数(BMI)[(25.7±3.5)kg/m^(2)与(25.1±3.6)kg/m^(2),P=0.518]及术前血肌酐[(102.9±31.6)μmol/L与(102.3±22.4)μmol/L,P=0.930]差异均无统计学意义。12例术中采用低温处理,其中RAPN组9例(20.9%),LPN组3例(12.5%,P=0.596)。比较两组手术时间、术中热缺血时间、术中失血量、术后禁食时间、围手术期并发症发生率、术后血肌酐等指标。用多因素线性回归分析术后血肌酐的影响因素。用Kaplan-Meier曲线分析患者预后生存情况,并采用log-rank检验比较组间差异;采用多因素Cox回归分析患者预后的影响因素。结果所有手术均顺利完成,病理切缘均为阴性,RAPN组与LPN组手术时间[(136.6±47.6)min与(125.3±34.4)min,P=0.311]、术中热缺血时间[23.0(16.0,30.0)min与19.0(13.5,27.5)min,P=0.260]、术中失血量[50.0(50.0,100.0)ml与50.0(22.5,100.0)ml,P=0.247]、术后住院时间[(6.6±3.5)d与(7.7±4.2)d,P=0.244]、术后引流管拔除时间[4(3,5)d与5(3,6)d,P=0.175]、术后禁食时间[(2.1±0.7)d与(2.2±1.0)d,P=0.729]、围手术期并发症发生率[18.6%(8/43)与16.7%(4/24),P=1.000]、术后血肌酐[145.2(128.3,191.3)μmol/L与157.8(136.2,196.3)μmol/L,P=0.229]及病理分期[T_(1a)/T_(1b)/T_(2a)/T_(3a)/T_(4)期32/7/1/3/0例与17/5/0/1/1例,P=0.804]差异均无统计学意义。Kaplan-Meier生存曲线显示RAPN组术后1、3、5年的总生存率分别为94.7%、84.9%、84.9%,LPN组分别为100.0%、95.5%、95.5%,log-rank�
Objective To compare the outcomes of robot-assisted laparoscopic partial nephrectomy(RAPN)and laparoscopic partial nephrectomy(LPN)in the treatment of tumors in isolated kidney,and analyze the factors influencing postoperative renal function and long-term survival in patients.Methods A retrospective analysis was conducted on clinical data of 67 patients with tumors in isolated kidney who underwent surgery at the Chinese PLA General Hospital from November 2010 to January 2022.There were 48 males and 19 females,with an average age of(58.6±10.1)years old.The patients were divided into RAPN group(43 cases)and LPN group(24 cases)based on the surgical approach.The RAPN group had a higher R.E.N.A.L.score than the LPN group[(8.7±1.5)vs.(7.9±1.7),P=0.042].There were no statistically significant differences between the two groups in terms of age[(57.4±10.2)years old vs.(60.9±9.8)years old,P=0.185],body mass index(BMI)[(25.7±3.5)kg/m^(2)vs.(25.1±3.6)kg/m^(2),P=0.518],and preoperative serum creatinine[(102.9±31.6)μmol/L vs.(102.3±22.4)μmol/L,P=0.930].Twelve cases underwent hypothermic treatment during surgery,with 9 cases(20.9%)in the RAPN group and 3 cases(12.5%)in the LPN group(P=0.596).Surgical time,intraoperative warm ischemia time,intraoperative blood loss,postoperative fasting time,perioperative complication rate,postoperative serum creatinine,and other indicators were compared between the two groups.Multiple linear regression analysis was used to identify factors affecting postoperative serum creatinine.Kaplan-Meier curves were employed to analyze patient prognosis,and log-rank tests were performed to compare the differences between the two groups.Multiple Cox regression analysis was used to identify factors influencing patient prognosis.Results All surgeries were completed successfully with negative pathological margins.There were no statistically significant differences between the RAPN and LPN groups in terms of surgical time[(136.6±47.6)min vs.(125.3±34.4)min,P=0.311],intraoperative ischemia time[23.0
作者
江彬
卢崯
赵旭鹏
程强
艾青
高帆
李宏召
Jiang Bin;Lu Yin;Zhao Xupeng;Cheng Qiang;Ai Qing;Gao Fan;Li Hongzhao(Department of Urology,the Third Medical Center of PLA General Hospital,Beijing 100853,China;Medical School of Nankai University,Tianjin 300071,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2024年第1期6-11,共6页
Chinese Journal of Urology
基金
国家重点研发计划(2022YFC3602901)。
关键词
肾肿瘤
孤立肾
肾部分切除术
机器人手术
腹腔镜手术
疗效
影响因素
Kidney neoplasms
Isolated kidney
Partial nephrectomy
Robot-assisted surgery
Laparoscopicsurgery
Efficacy
Influencing factors
