摘要
目的:总结单中心经腹机器人辅助腹腔镜下行巨大肾癌(肿瘤直径≥7cm)根治术的手术经验,探讨该技术的疗效及安全性。方法:回顾分析2008年10月~2015年4月应用达芬奇机器人辅助腹腔镜完成巨大肾癌根治性切除术29例的临床资料,总结巨大肾癌临床特点、手术经验、手术时间、术中并发症、术中出血量、术后住院时间等。结果:2008年10月~2015年4月共有101例行肾癌根治性切除,其中29例为巨大肾癌(占根治性肾切除的28.71%)。其临床特点为:男20例,女9例,平均(54.9±11.9)岁;左侧14例,右侧15例;肿瘤最大直径16cm,平均(9.56±2.36)cm;11例(39.29%)合并癌栓形成。29例均经腹腔途径完成,无中转开放;合并癌栓11例病例术前均行介入肾动脉栓塞;手术时间(164.4±40.0)min;术中出血量50~1 200ml。术后胃肠功能平均恢复(2.65±0.71)d;引流管拔除平均时间(3.17±1.36)d;术后平均住院(6.8±2.5)d。本组术中无十二指肠、肝脏、结肠及大血管损伤,术后无腹腔感染及术后肠梗阻。术后病理分期,T2N0~1M0~1期9例,T3N0~1M0~1期14例,T4N0~1M0~1期6例。随访1~24个月,肾床肿瘤复发或远处转移8例(27.6%)。结论:根据初期的手术操作经验和随访结果,经腹机器人辅助腹腔镜下行巨大肾癌根治术是安全和可行的,长期和前瞻性的对照研究将有助于对这一技术的评估。
Objective:To summarize the experience of transperitoneal approach robotic-assisted laparoscopic surgery in renal large tumor and to discuss the technical safety and surgical outcomes in single center.Methods:We retrospectively analyzed the clinic data of 29 patients with renal large tumor undergoing transperitoneal approach robotic-assisted laparoscopic surgery in our center,and summarized the clinical characteristics and operative outcomes.Results:101cases underwent robotic-assisted laparoscopic radical nephrectomy during 2008 October to 2015 April.Among all these cases,29 were diagnosed as renal large tumor(28.7% of the cases given radical nephrectomy),including 20 males and 9females with the mean age of(54.9±11.9)years old;.Fourteen tumors were located in the left kidney,and 15 in the right kidney.The maximum diameter was 16 cm and average diameter was(9.56±2.36)cm.Eleven cases(39.29%)were complicated with tumor thrombosis.Twenty cases were accomplished by transperitoneal approach and all procedures were technically successful without open conversion.All the 11 cases combined with tumor thrombus were treated with renal artery embolization.Average operative time was(164.4±40.0)min and average blood loss was 50-1 200 mL.The gastrointestinal function recovered in(2.65±0.71)days,and drains were removed in(3.17±1.36)days.The length of hospital stay after operationwas(6.8±2.5)days.No abdominal visceral or great vessel injury happened during the surgery,and no intra-abdominal infection or ileus occurred after surgery in all the cases.Tumor stage was pathologically classified as:9cases of T2N0-1M0-1,14 cases of T3N0-1M0-1and 6cases of T4N0-1M0-1.During follow-up period of 1-24 months,metastasis and recurrence were found in 8cases(27.6%).Conclusions:With initial surgery experience and shortterm follow-up,transperitoneal approach robotic-assisted laparoscopic surgery is safe and feasible for renal large tumor.Extensive surgical experiences,long-term and more randomized trials will be required to better assess the
出处
《微创泌尿外科杂志》
2016年第2期69-72,共4页
Journal of Minimally Invasive Urology
基金
国家高技术研究发展计划(863计划)(2014AA020607)
关键词
肾巨大肿瘤
肾癌根治术
机器人辅助腹腔镜
Renal large tumor
Radical nephrectomy
Robotic-assisted laparoscopic surgery
