智能互动定性定量分析三维立体成像导航技术支持下三维腹腔镜对比达芬奇机器人辅助技术在肾癌保留肾单位手术中的应用

Clinical application of intelligent/interactive qualitative and quantitative analysis three-dimensional stereo imaging navigation in three-dimensional laparoscopic nephron-sparing surgery versus Da Vinci robot assisted nephron-sparing surgery for renal cell carcinoma

目的比较智能互动定性定量分析(IQQA)三维立体成像导航技术支持下使用三维腹腔镜行保留肾单位手术(3DLNSS)与达芬奇机器人辅助技术行保留肾单位手术(RANSS)的临床应用价值。方法回顾性分析2016年2月—2019年6月海军军医大学第一医院、海军军医大学第二医院、海军军医大学第三医院和海军军医大学附属公利医院收治的163例肾癌患者的资料,根据手术方式分为3DLNSS组85例,RANSS组78例。比较患者的一般情况、手术时间、热缺血时间、术中出血量、手术接台时间、手术费用、留置导尿管时间、拔除负压引流管时间、术后住院天数、并发症、病理类型、手术前后血肌酐水平和术侧肾脏肾小球滤过率(GFR)。结果两组间患者的一般情况、手术时间、术中热缺血时间、术中出血量、术后禁食时间、术后留置导尿管时间、拔除负压引流管时间、术后住院天数、术后并发症发生率、病理结果、手术前和术后半年血肌酐水平和术侧肾脏GFR的差异均无统计学意义(P值均>0.05);RANSS组手术接台时间显著长于3DLNSS组(P<0.001),手术费显著高于3DLNSS组(P<0.001)。结论与RANSS相比,IQQA三维立体成像技术支持下3DLNSS的治疗效果佳,且有效地减轻患者的经济负担,提高了手术室周转效率,更适合在三级以下医疗机构逐步推广应用。

Objective To compare the clinical application of three-dimensional(3 D)laparoscopic nephron sparing surgery(3 DLNSS)supported by intelligent/interactive qualitative and quantitative analysis(IQQA)3 D stereo imaging navigation with Da Vinci robot technique assisted nephron sparing surgery(RANSS)in renal cell carcinoma(RCC).Methods A total of 163 RCC patients who underwent IQQA 3 D stereo imaging navigation assisted nephron sparing surgery(NSS)in the First Affiliated Hospital of Naval Military Medical University,the Second Affiliated Hospital of Naval Military Medical University,the Third Affiliated Hospital of Naval Military Medical University and the Gongli Hospital of Naval Military Medical University from February 2016 to June 2019 were enrolled in this study.3 DLNSS was performed in 85 patients and RANSS in 78 patients.General condition,operation time,warm ischemia time(WIT),intraoperative bleeding volume,preparation time between two surgeries,surgery cost,postoperative fasting time,catheterization time,negative pressure drainage time,postoperative hospitalization days,complications,pathological types,preoperative and postoperative creatinine and glomerular filtration rate(GFR)were collected and compared between two groups.Results There were no significant differences in the general condition,operation time,WIT,intraoperative bleeding volume,postoperative fasting time,catheterization time,negative pressure drainage time,postoperative hospitalization days,complications,pathological results,preoperative or postoperative creatinineor GFR between the two groups(all P>0.05).The preparation time between two surgeries of the RANSS group was significantly longer than that of the 3 DLNSS group(P<0.001).The operation cost of the RANSS group was significantly higher than that of the 3 DLNSS group(P<0.001).Conclusion Compared with RANSS,3 DLNSS supported by IQQA 3 D stereo imaging technology can effectively save patients’expenses and improve turnover efficiency of operating room while ensuring the treatment effect.