三维可视化成像技术在机器人辅助肾部分切除术治疗复杂肾肿瘤中的应用

Application of three-dimensional visualization imaging in robot-assisted partial nephrectomy in the treatment of complex renal tumors

目的:探讨三维可视化成像技术在机器人辅助肾部分切除术(robot-assisted partial nephrectomy,RAPN)治疗复杂肾肿瘤中的应用价值。方法:回顾性分析我院2020年05月至2022年08月收治的92例复杂肾肿瘤患者的临床资料。43例患者(A组)术前行三维可视化成像,其余49例患者(B组)未做。比较两组患者的手术时间、热缺血时间、术后24 h内血肌酐和血红蛋白变化值、术后拔管时间、术后住院时间等。结果:两组手术均顺利完成,无中转开放病例。A组相比B组热缺血时间显著缩短[(21.23±0.96)min vs (28.29±0.84)min,P<0.05]、术后24 h内血红蛋白下降量明显减少[(10.40±1.02)g/L vs (16.65±1.44)g/L,P<0.05]、术后住院时间显著缩短[(7.12±0.15)d vs (11.29±0.88)d,P<0.05]。两组患者手术时间、术后24 h内血肌酐上升值、术后拔管时间比较,差异均无统计学意义(P>0.05)。B组1例患者术后出现尿瘘,于术后第3天行输尿管支架置入术,后好转。结论:三维可视化成像技术可缩短RAPN治疗复杂肾肿瘤的热缺血时间、术后住院时间,减少术中出血量,降低并发症发生率,具有较大的临床应用价值。

Objective:To explore the application value of three-dimensional visualization imaging technique in robot-assisted partial nephrectomy(RAPN)in the treatment of complex renal tumors.Methods:The clinical data of 92 patients with complex renal tumors treated in our hospital from May 2020 to August 2022 were analyzed retrospectively.43 patients(group A)underwent three-dimensional visualization imaging before operation,and the other 49 patients(group B)not.The operation time,warm ischemia time,changes of serum creatinine and hemoglobin within 24 hours after operation,postoperative extubation time and postoperative hospital stay were compared between the two groups.Results:The operations in both groups were completed successfully and there was no case of conversion to open surgery.Compared with group B,the warm ischemia time in group A was significantly shortened[(21.23±0.96)min vs(28.29±0.84)min,P<0.05],the decrease in hemoglobin within 24 hours after operation was significantly reduced[(10.40±1.02)g/L vs(16.65±1.44)g/L,P<0.05],postoperative hospital stay was significantly shortened[(7.12±0.15)d vs(11.29±0.88)d,P<0.05].There was no significant difference in the operation time,the increase of serum creatinine within 24 hours after operation,and the time of extubation after operation between the two groups(P>0.05).One patient in group B developed urinary fistula after operation,and underwent ureteral stent placement on the 3rd day after operation,which improved after operation.Conclusion:Three-dimensional visualization imaging technology can shorten the warm ischemia time,postoperative hospital stay,reduce intraoperative blood loss,and reduce the incidence of complications in the treatment of complex renal tumors with RAPN,which has great clinical application value.