经腹腔和后腹腔入路机器人辅助腹腔镜下肾部分切除术治疗肾门肿瘤的临床研究

Clinical study of transperitoneal and retroperitoneal robot-assisted partial nephrectomy for renal hilar tumors

目的探讨经腹腔和后腹腔入路机器人辅助腹腔镜下肾部分切除术治疗肾门肿瘤的临床经验。 方法回顾分析2013年1月至2017年3月采用机器人辅助腹腔镜下肾部分切除术治疗的48例肾门肿瘤患者的临床资料。男35例，女13例。年龄41～75岁，平均57.3岁。肿瘤位于腹侧27例，背侧21例。肿瘤直径2.1～6.5 cm，平均3.5 cm。3例肿瘤完全位于肾实质内，45例部分凸出于肾实质外。48例均接受机器人辅助腹腔镜下肾部分切除术，其中经后腹腔途径18例，经腹腔途径30例。 结果本研究48例手术均顺利完成，均无中转开放手术。热缺血时间16～33 min，平均22 min。术中出血量50～350 ml，平均88 ml。术后均未出现出血相关并发症。术后病理诊断为透明细胞癌39例，血管平滑肌脂肪瘤7例，嗜酸细胞瘤2例。1例（2.1%）手术切缘阳性。术后随访2个月～4年，均未出现肿瘤复发或转移。 结论对肾门肿瘤采用经腹腔和经后腹腔入路机器人辅助腹腔镜下肾部分切除术是安全、有效的，在肾肿瘤的完整切除及肾脏创面的缝合上具有明显的优势。采取哪种手术入路需根据肿瘤的大小、位置及术者的临床经验等具体情况进行综合分析。

ObjectiveTo investigate the clinical value and experience of transperitoneal and retroperitoneal robot-assisted partial nephrectomy for renal hi1ar tumors. MethodsWe evaluated 48 patients who had partial nephrectomy for renal hilar tumor by robotic surgical syestem from January 2013 to March 2017. In those cases, 35 were male and 13 were female, with an average age of 57.3 （range from 41 to 75 ）, 27 cases were ventral tumor and 21 cases were dorsal tumor. 3 cases were totally confined to the renal parenchyma, the other 45 cases were partially confined to the renal parenchyma.18 cases were performed surgery by retroperitoneal route, the rest 30 cases were performed by peritoneal route. ResultsA total of 48 patients underwent successful robotic partial nephrectomy for renal hilar tumors. The mean warm ischemia time was 22 minutes （range from 16 to 33 minutes） and the mean estimated blood loss was 88 ml （range from 50 to 350 ml）. No bleeding-related complications were found. Histopathology confirmed 39 cases of ccRCC, 7 cases of angioleiomyolipoma, 2 cases of renal oncocytoma. There was one case in this review was positive surgical margin （2.1%） and found no sign of recurrence during the short term post-operation follow-up. All cases in this review are following up after surgery to date from 2 months to 4 years, no cases of tumor recurrence or metastasis were found. ConclusionsThe application of transperitoneal and retroperitoneal RAPN is the effective and safe way for renal hilar tumor resection, and it has a clear advantage of renal surgical incision stitching and tumor complete resection.The choice of surgical approaches depends on the size and location of tumor and the clinical experience of the surgeon.