R.E.N.A.L.评分N item=3分(Nearness≤4 mm)肾肿瘤肾部分切除术的手术设计与技巧

Surgical strategy and techniques of partial nephrectomy for renal tumors with Nearness item=3 in R.E.N.A.L.nephrometry

肾部分切除术(PN)是肾肿瘤外科治疗的重大进步。随着影像技术进展及机器人、高清腹腔镜平台的推广应用,PN已成为各大指南处理cT1a肾肿瘤的标准治疗术式,适应证范围不断扩大。PN的手术选择、手术技巧与策略仍存在巨大地域差异与术者差异。结合肾脏显微结构的新发现与机器人微创平台的认知,本文拟对R.E.N.A.L.评分N item=3分(nearness≤4 mm)的“复杂肾肿瘤”PN进行基于解剖学特征的图形分类并匹配与之对应的手术入路设计及切割技巧,将此类肾肿瘤的PN标准化,从而提高精准微创保留肾单位手术的质量与安全性。

Partial nephrectomy(PN)is one of the greatest progresses in the treatment of renal carcinoma.With the advancement of medical imaging and introduction of robotic and high-definition laparoscopic system,PN has become the standard recommendation for the cT1a renal tumors in major guidelines that further expand the indications for PN.However,there are still vast differences in the selection of patients,strategies and surgical techniques among regions and individual surgeons.Based on the discovery of kidney microstructure and our experience of robotic PN,the authors try to develop one graphic classification of renal tumors with N=3(nearness≤4 mm)in R.E.N.A.L.nephrometry,exploring the anatomical features,surgical approaches and techniques,in order to standardize the surgical procedures for this specific subgroup of renal tumors,thereby improving the quality and safety of precise and minimally invasive nephron-sparing surgery.