单中心机器人辅助腹腔镜与腹腔镜肾部分切除术的比较

Comparative study of single center between robotic assisted laparoscopic partial nephrectomy and laparoscopic partial nephrectomy

目的通过对机器人辅助腹腔镜肾部分切除术(RAPN)与腹腔镜肾部分切除术(LPN)治疗局限性肾癌的对比研究,探讨RAPN的优势和应用价值。方法回顾性分析西京医院泌尿外科2013年3月至2015年4月顺利完成RAPN(n=61)和LPN(n=32)患者的临床资料,对各组年龄、体质量指数(BMI)、R.E.N.A.L.评分、手术时间、温缺血时间、出血量、住院时间、术后并发症以及术后随访情况等进行统计学分析。结果总体两组间年龄、BMI、肿瘤直径、温缺血时间差异均无统计学意义(P>0.05),R.E.N.A.L.评分RAPN组大于LPN组(P<0.05),手术时间、出血量、住院时间RAPN组明显优于LPN组(P<0.05);肿瘤直径≤4cm组,RAPN组与LPN组年龄、BMI、肿瘤直径、温缺血时间差异均无统计学意义(P>0.05),R.E.N.A.L.评分RAPN组大于LPN组(P<0.05),手术时间、出血量、住院时间RAPN组明显优于LPN组(P<0.05);RAPN组内根据肿瘤直径分为≤4cm组和>4cm组,两组间BMI、出血量、住院时间差异均无统计学意义(P>0.05),两组间年龄、R.E.N.A.L.评分、手术时间、温缺血时间有显著性差异(P<0.05)。RAPN组术后并发肠梗阻2例,急性脑梗死1例,LPN组急性脑梗死1例(P>0.05);RAPN组术后2例复发、转移,其中1例死亡,余均无死亡及疾病进展发生。结论 RAPN是治疗局限性肾癌有效、可行的术式,较LPN有一定优势。

Obiective To comparatively analyze the clinical efficacy and safety between robot-assisted laparoscopic partial nephrectomy （RAPN） and laparoscopic partial nephrectomy （LPN）in treating renal cancer, aiming to investigate the advantages and application values of RAPN. Methods Clinical data of patients undergoing RAPN （n=61） and LPN （n=32） in the Department of Urology of Xijing Hospital between March 2013 and April 2015 were retrospectively analyzed. Age, body mass index （BMI）, R.E.N.A.L. nephrometry score, operation time, warm ischemia time, hemorrhage volume, length of hospital stay, postoperative complication and postoperative follow-up status were statistically analyzed and compared between the two groups. Results No significant differences were identified in age, BMI, tumor diameter and warm ischemia time between the two groups （all P〉0.05）. In the RAPN group, R.E.N.A.L. nephrometry score was significantly higher （P〈0.05） and operation time, hemorrhage volume and length of hospital stay were significantly less compared with those in the LPN group （all P〈0.05）. In the patients with tumor diameter ≤4 cm, no significant differences were documented regard to age, BMI, tumor diameter and warm ischemia time between the RAPN and LPN groups （all P〉0.05）. In the RAPN group, R.E.N.A.L. nephrometry score was significantly higher （P〈0.05）, whereas operation time, hemorrhage volume and length of hospital stay were significantly less than those in the LPN group （all P〈0.05）. In the RAPN group, no significant differences were identified in BMI, hemorrhage volume and length of hospital stay （all P〉0.05）, whereas age, R.E.N.A.L. nephrometry score, operation time and warm ischemia time significantly differed between patients with tumor diameter ≤4 cm and 〉4 cm （all P〈0.05）. In the RAPN group, two patients were complicated with intestinal obstruction after surgery and one was complicated with cerebral infarction. In the LPN group, one case was complicated with acute cerebral infarction （P〉0.05）. In the RAPN group, two patients had recurrence and metastasis and one died postoperatively. The remaining patients neither diednor presented with disease progression. Conclusion RAPN is an efficacious and feasible surgical technique in the treatment of renal carcinoma, which is superior to LPN.