达芬奇机器人辅助和传统腹腔镜下保留肾单位手术的临床比较分析

Comparison of laparoscopic nephron sparing surgery with and without robotic assistance

目的 对比采取达芬奇机器人和传统腹腔镜行保留肾单位手术治疗肾肿瘤的临床疗效、安全性、手术时间和住院时间.方法 回顾性对比分析86例患者因肾细胞癌接受保留肾单位手术的一般资料、手术时间、出血量、围手术期并发症、住院时间、手术治疗有效率、肿瘤复发率等指标.86例患者中,32例接受达芬奇辅助腹腔镜下保留肾单位手术（robot assisted lap-aroscropic nephron sparing surgery,RA-NSS）,54例接受传统腹腔镜下保留肾单位手术（conven-tional laparoscropic nephron sparing surgery,C-NSS）.结果 达芬奇辅助腹腔镜下保留肾单位手术组患者出血量、手术时间和住院时间分别为40.5 mL、112.6 min和5.9d,明显低于传统腹腔镜手术组的79.6 mL、132.4 min和7.5d（P＜0.05）.达芬奇辅助腹腔镜下保留肾单位手术组患者的年龄、性别组成、体重指数和R.E.N.A.L评分等均无明显统计学差异（P＞0.05）.两组患者围手术期并发症,手术有效率和肿瘤复发率均无统计学差异（P＞0.05）.结论 达芬奇辅助腹腔镜手术在泌尿外科重建手术中具有明显优势,并将逐渐替代传统腹腔镜,但是其昂贵的手术费用仍然成为其开展的障碍.

Objective To compare the clinical efficacy,safety,operation duration and hospital stay of robot-assisted laparoscropic nephron sparing surgery （RA-NSS） versus conventional laparoscropic nephron sparing surgery （C-NSS） for patients with renal cell carcinoma（RCC）.Methods Clinical data of 86 patients with RCC were analyzed and compared such as general information,operation time,blood loss,perioperative complications,hospital stay,surgical treatment,effective rate,tumor recurrence rate.Thirty-two patients underwent RA-NSS and 54 patients underwent C-NSS.Results There was no difference iu postoperative complications,radiographic success rate and tumor recurrence rate between the RA-NSS group and C-NSS group.Mean age,body mass index,gender,R.E.N.A.L score and RCC distribution were similar in the two groups.The mean estimated blood loss,average operative time and mean hospital stay in the RA-NSS group were significantly less than in the C-NSS group.Conclusions Da Vinci assisted laparoscopic surgery has obvious advantages in the reconstruction of the department of urology,and will gradually replace the traditional laparoscope,but its expensive operating costs become barriers of developing.