机器人辅助腹腔镜下射频消融术治疗肾肿瘤的临床观察

Clinical observation on robot-assisted laparoscopic radiofrequency ablation for renal tumor

目的:总结机器人辅助腹腔镜下射频消融术的手术经验,并初步探讨此手术在临床中的应用价值。方法:回顾性分析2016年3月~2017年5月于我院泌尿外科接受机器人辅助腹腔镜下肾肿瘤射频消融术的19例患者的临床资料,术中完全暴露肿瘤相应位置,采用超声及超声造影实时监测肾肿瘤射频消融治疗,对于与集合系统位置关系紧密的患者采用输尿管导管灌注低温盐水进行集合系统物理降温。术后复查血肌酐及肾小球滤过率(GFR),定期行CT、MRI随访。手术前后数据比较采用配对t检验。结果:19例患者均顺利完成手术,手术时间61~172min,中位时间103min,射频时间6~36min,中位时间17min;术后1周血肌酐基本维持术前水平,术后3个月行GFR检查与术前比较差异无统计学意义,影像学检查未见肿瘤残留及复发。结论:机器人辅助腹腔镜下射频消融术对于位置复杂的肾肿瘤治疗安全有效,相较于传统腹腔镜辅助下射频消融具有更为广泛的应用,局限性为手术花费较高,需严格把控手术指征。

Objective：To state our experience on robot-assisted laparoscopic radiofrequency ablation for renal tumor and evaluate the application value of this operation.Method：The data of 19 patients who underwent robotassisted laparoscopic radiofrequency ablation were analysed from March 2016 to May 2017 in Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School.We made a clear exposure of the tumor location and supervised the ablation prossess by the real-time ultrasound and contrast-enhanced ultrasonograph during the radiofrequency ablation.Ice saline was injected through ureteral catheter for cooling the collecting system for patients whose tumor adjoin the collecting system.The postoperative serum creatinine and glomerular filtration rate（GFR）data were collected and all patients were followed up with enhanced CT or MRI.The pre-and post-operative data were compared by paired t test.Result：All the 19 patients underwent the robot-assisted laparoscopic radiofrequency ablation successfully.The operation time ranged from 61 to 172 minutes and the median time was 103 minutes.The ablation time ranged from 6 to 36 minutes and the median time was 17 minutes.The postoperative serum creatinine during the first postoperative week was no significant statistic difference compared to the preoperative level.There was also no significant statistic difference between the pre-and post-operative GFR.No evidences of tumor residual or local recurrence by the imageological examination were found.Conclusion：Robot-assisted laparoscopic radiofrequency ablation could be performed safely and effectively and it could be more widely applied compared with the traditional laparoscopic radiofrequency ablation,but it need more expensive cost.The surgical indication should be controlled strictly.