机器人辅助、3D及传统腹腔镜在保留肾单位手术中的对比研究

Comparison of robot-assisted, 3D and traditional laparoscopic nephron sparing surgery

目的 比较机器人辅助腹腔镜肾部分切除术（RAPN）、3D腹腔镜（3D）及传统腹腔镜（LPN）在肾肿瘤保留肾单位手术的疗效和临床使用价值。方法 回顾性分析该院2012年8月-2015年4月收治的腹腔镜保留肾单位手术90例肾肿瘤患者的临床资料,其中RAPN组21例、3D组30例和LPN组39例。比较3组手术时间、热缺血时间、术中出血量、引流管引流量、术后住院时间、住院费用及术后并发症情况的差异。结果 3组手术时间分别为（129.0±13.9）、（123.9±18.7）和（137.0±22.1）min,3D组与LPN组差异有统计学意义（P〈0.05）,RAPN组和3D组、LPN组差异无统计学意义（P〉0.05）;热缺血时间分别为（18.1±5.1）、（22.2±6.5）和（25.7±5.4）min,3组间差异均有统计学意义（PP〈0.05）;住院费用分别为（46 858.3±3 057.2）、（21 904.8±2 404.3）和（21 019.7±1 478.9）元,RAPN组与3D组、LPN组差异有统计学意义（P〈0.05）,3D组和LPN组差异无统计学意义（P〉0.05）;术中出血量、引流管引流量、术后住院时间各组间差异均无统计学意义（P〉0.05）;3D组1例切口延迟愈合,LPN组1例切口延迟愈合和2例肾周血肿,保守治疗后均治愈,3组手术切缘均阴性;随访1~32个月,未见复发和转移,肾功能正常。结论 传统腹腔镜推广简单且费用少;3D腹腔镜的三维视野和经济性的优势有着广阔的应用前景;机器人辅助腹腔镜手术操作最灵活,将成为未来医学发展的主流术式。

[Objective] To compare clinical outcomes of robot-assisted laparoscopic, 3D Iaparoscopic and traditional laparoscopic nephron sparing surgery （NSS）. [Methods] From March 2012 to April 2015, 90 patients underwent laparoseopic nephron sparing surgery in our hospital due to renal carcinoma, including robot-assisted laparoscopic NSS in 21 patients, 3D laparoscopic NSS in 30 patients and traditional laparoscopic NSS in 39 patients. Their data were retrospectively reviewed. [Results] The operative time were （129.0 ± 13.9） min, （123.9 ±18.7） min and （137.0 ± 22.1） min, respectively. There was significant difference between 3D group and LPN group, while no significant difference was found between RAPN group, 3D group and LPN group （P 〉 0.05）. The renal warm ischemia time was （18.1 ± 5.1） min, （22.2 ± 6.5） rain and （25.7 ± 5.4） rain, respectively. There was significant difference between each group （P 〈 0.05）. The total hospitalization charge was （46 858.3 ± 3 057.2）, （21 904.8 ± 2 404.3） and （21 019.7 ± 1 478.9）, respectively. There was significant difference between RARP group, 3D group and LPN group, while no significant difference was found between 3D group and LPN group （P 〉 0.05）. However, the estimated blood loss,volume of drainage and postoperative hospital stay were similar between the 3 groups （P 〉 0.05）. Each I case of 3D and LPN group was found delayed wound healing, and another 2 cases of peri-renal hematoma were also noticed in LPN group. All complications were cured; Follow-up ranged from 1 to 32 months, no tumor recurred and/or metasta- sis developed. All resection margins were negative. [ Conclusions ] Traditional laparoseopy was easy to apply and economic; 3D three-dimensional vision and low price has broad application prospects in 3D laparoscopy; the flexible surgical action of robot-assisted laparoscopic NSS make it the main method in the future of medical development.