机器人辅助腹腔镜与后腹腔镜肾部分切除术治疗早期肾癌的疗效比较

Comparative study between robotic-assisted transperitoneal laparoscopic partial nephrectomy and retroperitoneal laparoscopic partial nephrectomy in treatment of early renal carcinoma

目的比较机器人辅助经腹腹腔镜肾部分切除术(RALPN)与后腹腔镜下肾部分切除术(RLPN)治疗早期肾癌的疗效和安全性,探讨RALPN的临床应用价值。方法选取2010年5月至2013年10月收治的70例肾癌患者,根据术式的不同分为RALPN组(n=36)和RLPN组(n=34)。比较两组手术时间、肾动脉阻断时间、术中出血量、术中输血率、术后住院时间及术后并发症发生情况。结果除RLPN组有2例术中转开放手术,两组均成功完成手术。RALPN组和RLPN组的手术时间、肾动脉阻断时间、术中出血量、术后住院时间分别为(90.5±12.6)min和(110.7±20.3)min、(15.2±5.8)min和(24.6±7.2)min、(50.2±9.5)ml和(130.2±22.4)ml、(6.1±1.7)d和(7.8±2.2)d,两组比较差异均有统计学意义(P<0.05)。RALPN组和RLPN组的术中输血率分别为0和11.8%。RALPN组术后出现1例肾周血肿,RLPN组出现1例尿漏和2例继发性出血。两组在随访期间均为无瘤生存。结论 RALPN是治疗肾癌安全、有效的微创术式。

Objective To compare the efficacy and safety between the robotic-assisted transperitoneal laparoscopic partial ne-phrectomy（ RALPN） and retroperitoneal laparoscopic partial nephrectomy（ RLPN） in treating early renal carcinoma. Methods Retro-spective review of 70 renal carcinoma patients from May 2010 to October 2013 was conducted. Thirty-six patients were performed with RALPN（ RALPN group） , and 34 patients underwent RLPN（ RLPN group） . The operation time, renal artery clamping time, intraoper-ative blood transfusion, blood loss, postoperative hospital stay and post-operative complications between the two groups were observed and compared. Results Both the two groups were performed successfully, and 2 cases intraoperatively convered to open surgery in RLPN group. The operation time, renal artery clamping time, blood loss and postoperative hospital stay of RALPN and RLPN group were（90. 5±12. 6）min and（110. 7±20. 3）min,（15. 2±5. 8）min and（24. 6±7. 2）min,（50. 2±9. 5）ml and（130. 2±22. 4）ml, （6. 1± 1. 7）d and （7. 8±2. 2）d. There were significant differences between the two groups （P〈0. 05）. The intraoperative blood transfusion between RALPN group and RLPN group were 0 and 11. 8%. In RALPN group, perirenal hematoma post-operation was found in one case, and in RLPN group, one case of urine leakage and 2 cases of secondary hemorrhage were found post-operation. All patients were of turmor-free survival. Conclusion RALPN is a quite effective, safe and minimally invasive surgical management for renal carcinoma with less post-operative complications.