全息影像在机器人辅助腹腔镜肾部分切除术中的优势

Advantages of holographic display in robot-assisted laparoscopic partial nephrectomy

目的分析将全息影像技术应用于机器人辅助腹腔镜肾部分切除术导航中的有效性和安全性。方法回顾性分析了2019年11月-2021年1月由中国人民解放军中部战区总医院同一术者完成机器人辅助腹腔镜肾部分切除术的44例难治性肾肿瘤患者(RENAL评分≥7分)的临床资料,根据术中是否使用全息影像实时导航分为全身影像实时术中导航(HRLPN)组和非全身影像实时术中导航(RLPN)组。记录两组患者的术中及术后3个月的随访情况。结果两组患者手术均顺利完成,HRLPN组较RLPN组的手术时间[(110.8±8.18)min vs.(135.8±8.66)min]、血管分离时间[(62.85±4.61)min vs.(77.88±4.43)min]、热缺血时间[(26.13±0.95)min vs.(30.23±0.72)min]短,差异有统计学意义(P<0.05)。两组均未发生术中并发症,无术中转开放手术或根治性肾切除术,术后所有患者的病理切缘均为阴性。HRLPN组与RLPN组的肿瘤切除时间、术中失血量、术后3个月的血肌酐和预估肾小球滤过率差异均无统计学意义(P>0.05)。结论机器人辅助腹腔镜肾部分切除术应用全息影像实时术中导航可缩短手术时间、热缺血时间和血管分离时间,减少术中血管及正常肾组织的损伤。

Objective To analyze the efficacy and safety of holographic display(HD)in robot-assisted laparoscopic partial nephrectomy(RLPN).Methods Clinical data of 44 patients with refractory renal tumor(RENAL score≥7)who underwent RLPN by the same operator in the Central Theater General Hospital of Chinese PLA during Nov.2019 and Jan.2021 were retro⁃spectively analyzed.According to whether holographic real-time navigation was used,the patients were divided into two groups:holographic RLPN(HRLPN)group and RLPN group.The intraoperative and 3-month postoperative data of the two groups were recorded.Results Surgery was successfully completed in both groups.Compared with HRLPN group,RLPN group had more operative time[(110.8±8.18)min vs.(135.8±8.66)min],vascular separation time[(62.85±4.61)min vs.(77.88±4.43)min],and heat ischemia time[(26.13±0.95)min vs.(30.23±0.72)min],and the difference was statistically sig⁃nificant(P<0.05).No intraoperative complications occurred in the two groups,with no intraoperative conversion to open sur⁃gery or radical nephrectomy,and all postoperative pathological margins were negative.There were no significant differences in tumor resection time,intraoperative blood loss,serum creatinine 3 months after surgery and estimated glomerular filtration rate between HRLPN group and RLPN group(P>0.05).Conclusion Holographic real-time navigation in RLPN can shorten the operation time,warm ischemia time and vascular separation time,reduce the injury on blood vessels and normal renal tissue.