机器人辅助肾部分切除术治疗孤立肾肿瘤的临床疗效分析

Clinical Analysis of Robot-Assisted Partial Nephrectomy for Isolated Renal Tumors

[目的]探讨机器人辅助肾部分切除术治疗孤立肾肿瘤的临床疗效。[方法]回顾性分析2016年6月至2018年1月本院收治的12例行机器人辅助肾部分切除术治疗的孤立肾肿瘤患者的临床资料,其中1例为对侧肾萎缩,2例为先天性孤立肾,1例曾行对侧肾良性疾病切除术,8例曾行对侧肾恶性肿瘤全切术。所有患者均行机器人辅助肾部分切除术治疗,记录患者手术情况,并随访12个月,记录所有患者术后并发症发生情况及预后情况。[结果]12例患者的手术均顺利完成,术中未有转开放手术病例,手术时间108~210 min,平均(163.5±15.4)min;术中出血量120~460 mL,平均(240.6±25.7)mL;住院时间6~15 d,平均(9.8±2.1)d。术后病理诊断:9例肾透明细胞癌,3例血管平滑肌瘤,切缘均为阴性,肿瘤包膜均较为完整。1例患者术后发生血尿,1例患者发生感染,给予相关有效干预后均恢复正常。随访3个月,12例患者血肌酐、尿素氮、肾小球滤过率、尿白蛋白等肾功能指标均正常;随|访6个月,1例患者出现血肌酐、尿素氮轻度升高;随访9个月,2例患者出现血肌酐、尿素氮明显升高、蛋白尿定性检查为阳性;随访12个月,1例患者肾小球滤过率<100 mL/min,但未有患者进行肾脏透析,均无肿瘤复发及转移。[结论]机器人辅助肾部分切除术能有效保留孤立肾肿瘤患者的肾功能,具有较高的安全性,值得推广应用。

[Objective]To investigate the clinical efficacy of robot assisted partial nephrectomy in the treatment of solitary renal tumors.[Methods]The clinical data of 12 patients with solitary renal tumors treated by robot assisted partial nephrectomy in our hospital from June 2016 to January 2018 were retrospectively analyzed,including 1 case of contralateral renal atrophy,2 cases of congenital solitary kidney,1 case of contralateral benign renal disease and 8 cases of contralateral malignant renal tumor.All patients underwent robot assisted partial nephrectomy.The operation conditions were recorded and followed up for 12 months.The incidence of postoperative complications and prognosis were recorded.[Results]The operation of 12 patients was successfully completed,and there was no conversion to open operation.The operation time was 108~210 min,with an average of(163.5±15.4)min;The intraoperative bleeding volume was 120~460 mL,with an average of(240.6±25.7)mL;The hospital stay was 6~15 days.with an average of(9.8±2.1)days.Postoperative pathological diagnosis:9 cases of renal clear cell carcinoma and 3 case of angioleiomyoma,the cutting edge was negative,and the tumor capsule was relatively complete.One patient developed hematuria and one patient developed infection.All patients returned to normal after relevant effective intervention.Following up for 3 months,12 patients had normal renal function indexes such as serum creatinine,urea nitrogen,glomerular filtration rate and urinary albumin;Followed up for 6 months,1 patient had a slight increase in serum creatinine and urea nitrogen;After 9 months of follow-up,2 patients had significantly increased serum creatinine and urea nitrogen,and the qualitative examination of proteinuria was positive;After 12 months of follow-up,the glomerular filtration rate of 1 patient was less than 100 ml/min,but no patient underwent renal dialysis,and there was no tumor recurrence and metastasis.[Conclusion]Robot assisted partial nephrectomy can effectively preserve the renal function of patients with solitary renal tumor,has high safety.and is worthy of popularization and application.