单中心机器人辅助腹腔镜根治性肾切除术52例临床分析

Clinical analysis of robotic radical nephrectomy:a single-center experience(Report of 52 cases)

目的:总结机器人辅助腹腔镜根治性肾切除术的手术经验,探讨该技术的疗效及安全性。方法:回顾分析2013年6月~2014年6月,应用达芬奇机器人辅助腹腔镜技术完成根治性肾切除术52例的临床资料。结果:52例手术均经腹腔途径完成,手术过程顺利,无机器人故障或其他原因导致中转开放或中转常规腹腔镜病例,无术中输血,无术中及术后并发症。手术时间80~270min,平均(164.4±40.0)min;术中出血20~700ml,平均(134.2±132.8)ml;胃肠功能恢复时间1~4d,平均(2.8±0.7)d;引流管拔除时间1~7d,平均(3.2±1.4)d;术后住院4~17d,平均(6.7±2.6)d。术后病理检查示:肾透明细胞癌48例,嫌色细胞癌2例,肾乳头状肾细胞癌1例,肾囊性肾瘤1例。肿瘤最大直径1~8.2cm,平均(3.9±1.8)cm。术后随访1~12个月,平均7个月,无局部肿瘤复发、切口种植及远处转移。结论:机器人辅助腹腔镜根治性肾切除术安全可靠。

Objective:To summarize our clinical experience of robotic radical nephrectomy(RRN),and to discuss its efficacy and safety.Methods:A retrospective chart review was perfomed,and consecutive RRNs using da Vinci S surgical system were done through transperitoneal access in our center.Results:The procedures were completed and no complication and transfusion occurred in all patients.The mean operative time,intraoperative blood loss,orally allowed time,drain removal time and hospital stay were 164.4±40.0min(range 80-270),134.2±132.8mL(range 20-700),2.8±0.7day(range 1-4),3.2±1.4day(range 1-7)and 6.7±2.6day(range 4-17),respectively.The final pathologic examination revealed conventional clear cell carcinoma in 48 patients,chromophobecell renal carcinoma in 2patients,papillary renal cell carcinoma in 1patient and cystic nephroma in 1patient,respectively.The mean tumor size was 3.9±1.8cm(range 1-8.2).During a follow-up period of 1to 12 months.no local residual lesions,1ocal recurrence,incision implantation and distant metastasis were found in all patients.Conclusions:We conclude that RRN is a feasible and safe procedure.