经腹膜后入路机器人手术治疗肾肿瘤的技术与经验的探讨(附45例报告)

Robotic surgical resection of renal tumor via retroperitoneal approach:report of 45 cases

目的：探讨经腹膜后入路机器人手术治疗肾肿瘤的操作技术,总结其临床经验。方法：我院于2014年12月-2015年10月期间施行经腹膜后入路的机器人根治性肾切除术（robotic radical nephrectomy,RRN）25例（RRN组）,机器人肾部分切除术（robotic partial nephrectomy,RPN）20例（RPN组）。结果：45例肾肿瘤患者均成功完成手术,无中转开放手术者,术中术后无明显并发症发生。所有手术均未因机械臂体内外碰撞而影响手术操作,床边助手无操作障碍。其中RRN组平均手术时间84.4 min,平均失血量53.6 ml,术后平均住院天数4.9d;RPN组平均手术时间104.8min,平均失血量90.5ml,4例未阻断肾动脉,16例阻断手术侧肾动脉,均未阻断肾静脉,平均热缺血时间19.0min,术后平均住院天数8.2d。术后病理检查示切缘均为阴性。结论：严格掌握手术适应证,手术开展早期遵循先易后难的病例选择原则,采用经腹膜后入路进行机器人根治性肾切除术和肾部分切除术是安全有效的,肿瘤控制效果满意。

Objective：To explore the technique and summarize the clinical experience of robotic surgery through retroperitoneal approach for renal tumors.Method：From December 2014 to October 2015,through retroperitoneal approach 25 cases underwent robotic radical nephrectomy（RRN）and 20 cases underwent robotic partial nephrectomy（RPN）.Result：All 45 operations were successful without conversion or significant perioperative complications.No arm collision was encountered.There was no conflict between robotic arms and the bedside assistant.Mean operative time for RRN and RPN were 84.4min and 104.8min respectively.Mean blood loss was 53.6ml for RRN cases and 90.5ml for RPN cases.Renal artery was clamped for 16 RPN cases with a mean warm ischemia time of 19.0min,while the remaining four RPN cases were unclamped.Postoperative hospital stay was 4.9days and 8.2days for RRN and RPN patients,respectively.Postoperative pathological study confirmed negative surgical margin for all cases.Conclusion：Patient selection and preoperative assessment are of utter most importance for RPN and RRN.Our data suggest that retroperitoneal approach can be feasible,safe and effective for RPN and RRN.Satisfactory tumor control can be seen.