机器人辅助腹腔镜肾肿瘤精准剜除术治疗复杂内生性中央型肾窦部肿瘤的初步体会

Robot assisted laparoscopic precise enucleation for complex central located renal hilum tumors: feasibility and outcomes

目的探讨复杂内生性中央型肾窦部肿瘤行机器人辅助腹腔镜肾肿瘤精准剜除术的安全性及可行性。方法回顾性分析2017年7月至2018年10月收治的7例复杂内生性中央型肾窦部肿瘤患者的病例资料,男5例,女2例。平均年龄56.5岁(45~68岁)。平均体质指数25.1 kg/m2(19.8~29.2 kg/m2)。肿瘤位于左侧4例,右侧3例。肿瘤直径平均3.5 cm(2.2~4.5 cm)。R.E.N.A.L.评分平均9.7分(9~11分)。术前患肾GFR平均44.5 ml/min(36.5~51.7 ml/min)。7例均由单术者行机器人辅助腹腔镜肾肿瘤精准剜除术。术中充分游离肾门,仔细分离各分支血管及集合系统,完全游离肾脏并对肾脏做二次悬挂固定,阻断肾动脉后再次彻底精细解剖肾门,紧贴肿瘤包膜,将各分支血管及集合系统剥离肿瘤表面,剜除肿瘤,创面行点对点缝合,并以止血材料加压填塞。结果本组7例手术均顺利完成,无中转肾切除术及开放手术。手术时间平均175.0 min(133~224 min),热缺血时间平均27.3 min(22~38 min),术中出血量平均155.7 ml(50~250 ml)。术后1例出现肉眼血尿,予静卧及膀胱冲洗后好转。术后病理诊断均为透明细胞癌,切缘均为阴性。术后随访3个月,患肾GFR平均29.3 ml/min(23.9~33.2 ml/min),7例均无肿瘤复发及转移。结论机器人辅助腹腔镜肾肿瘤精准剜除术是治疗复杂内生性中央型肾窦部肿瘤的安全可行的微创手术方式,技术娴熟的术者可尝试开展。

Objective To investigate the safety and feasibility of robot assisted laparoscopic precise enucleation for complex central located renal hilum tumors. Methods From July 2017 to October 2018, a single surgeon completed seven robot assisted laparoscopic precise enucleations for complex central located renal hilum tumors. There were five males and two females with an average age of 56.5 years (45-68 years), an average body mass index of 25.1 kg/m2(19.8-29.2 kg/m2), four cases on the left side and three cases on the right side. The average tumor diameter was 3.5 cm, ranging(2.2-4.5 cm). The R. E.N.A.L. score was 9.7 (9-11). The average preoperative GFR was 44.5 ml/min (36.5-51.7 ml/min). The surgery was completed step by step as follow: the renal hilum was fully dissociated.The arteries, veins and collective system were completely freed. After blocking the renal artery, the renal hilum was completely dissected again. The tumor was enucleated precisely, and the wound was given a point-to-point suture. Results All operation were completed safely and successfully without conversion to nephrectomy and open surgery. The average operative duration was 175.0 min (133-224 min). The average warm ischemia time was 27.3 min (22-38 min) and the intraoperative blood loss was 155.7 ml(50-250 ml). One patient had gross hematuria after surgery. Postoperative pathology showed clear cell carcinoma and the margins were negative. After three months, the average GFR was 29.3 ml/min (23.9-33.2 ml/min). There was no tumor recurrence and metastasis. Conclusions Robot assisted laparoscopic precise enucleation is a safe and feasible surgery for complex central located renal hilum tumors, and it is worth further promotion.