应用第四臂提升经后腹腔机器人辅助腹腔镜肾部分切除术治疗T1b期肾肿瘤的疗效

Efficacy of using the fourth arm in retroperitoneal robot-assisted partial nephrectomy for cT1b stage renal tumors

目的 探讨在经后腹腔机器人辅助腹腔镜肾部分切除术(PN)治疗T1b期肾肿瘤中应用第四臂的疗效和安全性。方法 回顾性分析2022年1月—2023年12月上海交通大学医学院附属新华医院泌尿外科同一术者采用经后腹腔入路机器人辅助腹腔镜PN治疗的49例T1b期肾肿瘤患者的临床资料,根据术中是否应用第四臂将患者分为应用组(n=21)和未应用组(n=28)。比较两组的一般资料、手术时间、热缺血时间、术中失血量和术后并发症发生情况等。结果 49例T1b期肾肿瘤患者手术均顺利完成,无中转开放手术或根治性肾切除术的发生。应用组较未应用组的手术时间[(128.76±31.58)min vs.(151.11±33.21)min,P=0.021]、热缺血时间[(24.67±4.80)min vs.(27.61±3.54)min,P=0.017]更短,术中失血量更少[(109.05±39.99)mL vs.(139.29±54.43)mL,P=0.037]。应用组与未应用组术后肌酐分别上升(18.64±16.05)、(20.30±13.49)μmol/L。应用组3例、未应用组5例术后发生并发症,差异无统计学意义(P>0.05)。结论 采用经后腹腔机器人辅助腹腔镜PN治疗T1b期肾肿瘤时,应用第四臂可缩短手术时间和热缺血时间、降低术中失血量,值得在临床推广应用。

Objective To investigate the efficacy and safety of using the fourth arm in retroperitoneal robot-assisted partial nephrectomy(PN)for cTlb stage renal tumors.Methods Clinical data of 49 patients with cTb stage renal tumors who underwent retroperitoneal robot-assisted PN performed by the same surgeon in our hospital during Jan.2022 and Dec.2023 were retrospectively analyzed.The patients were divided into two groups based on whether the fourth arm was used or not:application group(n=21)and non-application group(n=28).The basic information,operation time,warm ischemia time,intraoperative blood loss,postoperative complications and other data were compared between the two groups.Results All operations were successful,with no conversion to open surgery or radical nephrectomy.The application group had significantly shorter operation time[(128.76±31.58)min vs.(151.11±33.21)min,P=0.021],shorter warm ischemia time[(24.67±4.80)min vs.(27.61±3.54)min,P=0.017],and less intraoperative blood loss[(109.05±39.99)mL vs.(139.29±54.43)mL,P=0.037]compared with the non-application group.The increase of postoperative creatinine was(18.64±16.05)μmol/L in the application group and(20.30±13.49)μmol/L in the non-application group respectively.Complications occurred in 3 cases in the application group and 5 cases in the non-application group,with no significant difference(P>0.05).Conclusion When we perform the retroperitoneal robot-assisted partial nephrectomy for cT1b stage renal tumors,using the fourth arm can shorten the operation time and warm ischemia time,and reduce the intraoperative blood loss,which should be applied more in clinic.