四钩定位针联合全息影像在机器人辅助肾部分切除术治疗完全内生型肾肿瘤中的临床应用

Clinical application of four-hook needle combined with holographic image in robot-assisted partial nephrectomy for completely intrarenal tumors

目的探讨四钩定位针联合全息影像在机器人辅助肾部分切除术治疗完全内生型肾肿瘤中的安全性和有效性。方法回顾性分析中部战区总医院在2023年10-12月采用四钩定位针联合全息影像引导机器人辅助肾部分切除术治疗的8例完全内生型肾肿瘤患者的临床资料。男6例,女2例;年龄(44.5±12.0)岁。肿瘤位于左侧6例,右侧2例;肿瘤最大径为(23.2±8.1)mm,均为T1a期。R.E.N.A.L.评分(9.0±1.4)分。术前血肌酐(73.1±14.7)μmol/L。术前在CT引导下用四钩定位针穿刺定位于完全内生型肾肿瘤边缘,术中在四钩定位针及全息影像引导下精准刻除肿瘤。分析手术时间、热缺血时间、切缘阳性率、住院时间、病理结果、术后肾功能等。结果8例患者均在全息影像及四钩定位针引导下顺利完成机器人辅助肾部分切除术,无改行根治性肾切除术或开放手术者。手术时间为(117.0±14.5)min,热缺血时间(20.2±5.1)min,术中出血量(75.0±17.3)ml,住院时间(9.5±1.3)d,术后1周血肌酐(73.2±14.8)μmol/L,与术前差异无统计学意义(P=0.952)。所有患者均未输血。8例患者病理结果均为透明细胞性肾细胞癌,切缘均阴性。结论对于完全内生型肾肿瘤,四钩定位针联合全息影像引导有助于术者快速定位肿瘤,精准刻除肿瘤,围手术期并发症少,安全有效。

Objective To investigate the safety and efficacy of four-hook needle combined with holographic image in robot-assisted partial nephrectomy for completely intrarenal tumors.Methods sThe clinical data of 8 patients with completely intrarenal tumors treated by robot-assisted partial nephrectomy with four-hook needle combined with holographic image admitted to General Hospital of Central Theater Command from October 2023 to December 2023 were retrospectively analyzed.There were 6 males and 2 females,with average age of(44.5±12.0)years old.Tumors of 6 cases were in the left side and 2 cases in the right side.The maximum diameter of the tumor was(23.2±8.1)mm.The R.E.N.A.L.score was(9.0±1.4).The preoperative serum creatinine(Scr)was(73.1±14.7)μmol/L.CT-guided four-hook needle was used to locate the edge of completely intrarenal tumor before surgery.During the operation,the tumor was precisely resected under the guidance of hologram and four-hook needle.Perioperative data of patients were collected and analyzed.Results All the tumor were successfully resected under the guidance of four-hook needle and hologram without conversion to radical nephrectomy or open surgery.The mean operative time was(117.0±14.5)min,the mean hot ischemia time was(20.2±5.1)min,the mean intraoperative blood loss was(75.0±17.3)ml,and the average hospitalization time was(9.5±1.3)days.The one week postoperative Scr was(73.2±14.8)μmol/L,which had no significant difference with that of before operation(P=0.952).None of them received blood transfusion.The pathology results of 8 patients were clear cell renal cell carcinoma,and the surgical margins were negative.Conclusions For completely intrarenal tumors,the four-hook needle combined with the hologram can guide the surgeon to quickly locate the tumor,accurately resect the tumor,reduce perioperative complications,and is safe and effective。