机器人辅助腹腔镜剜除加肾部分切除治疗肾错构瘤6例报告

Enucleation and Partial Nephrectomy Utilizing the DaVinci S System to Treat Renal Angioleiomyolipoma:Report of 6 Cases

目的:总结机器人辅助腹腔镜剜除加肾部分切除治疗肾错构瘤的手术经验,探讨此术式的疗效及安全性。方法:2008年8月～2009年1月,在机器人(Da Vinci S手术机器人系统)辅助腹腔镜下对6例肾错构瘤患者行剜除加切除手术,肾皮质部分肿块采用剜除方法,肾髓质部分肿块采用肾部分切除方法。收集手术相关资料后与国外此手术初期的相关资料及我院同组人员腹腔镜保留肾单位肾部分切除术的资料进行比较分析。结果:6例手术均取得成功,无一例转换术式。肿瘤平均直径6.3(2～20)cm,手术时间(不包括术前机器人准备时间)158(120～210)min,肾动脉阻断时间29(20～45)min,术中出血量388(30～1000)ml,术后5～6天下床活动,3天拔除引流管,术后住院8(7～9)天。术后病理检查提示6例均为肾错构瘤。随访21～24个月,所有患者未见局部病灶残留,肾功能均在正常范围。结论:机器人辅助腹腔镜下剜除加切除治疗肾错构瘤操作灵活,创伤小,安全可靠,疗效确切。

Objective：To summarize our clinical experience and to review our technique of robot-assisted laparoscopic enucleation and partial nephrectomy（RALPN） for renal angiomyolipoma（RAML） utilizing the DaVinci S system. Methods：Between August 2008 and January 2009, 6 patients with RAML underwent intraperitoneal robotassisted laparoscopic enucleation and partial nephrectomy. The perioperative data were collected, and were com- pared with those performed the same operation in external and those performed laparoscopic partial nephrectomy （LPN） with the same team in internal. Results：All the operations were accomplished successfully without conversion to open surgery. The mean lesion diameter was 6.3 （2-20） cm; the mean preoperative set-up time of the Da- Vinci surgical system was 30 minutes; the mean operative time was 158 （120-210） minutes; the mean estimated blood loss was 388 （30-1000） ml; the mean warm ischemia time were 29 （20-45） minutes and mean hospital stay was 8 （7-9） days. The patients were ambulant between the 5th and 6th postoperative days. The postoperative pathology revealed all patients were RAML. All patients were followed up for 21-24 months. During this period, radiological examination found no local residual tumor, and the postoperative serum Cr and Bun level was normal. Conclusions： Robot-assisted laparoscopic enucleation and partial nephrectomy can be safely performed in RAML patients, it is a feasible approach and a minimally invasive operation for small renal tumors.