机器人辅助后腹腔镜肾部分切除术(附21例报道)

Robot-assisted retroperitoneal laparoscopic partial nephrectomy for renal cell carcinoma(report of 21 cases)

目的:总结机器人辅助后腹腔镜肾部分切除术(RARPN)的临床经验和疗效。方法:回顾性分析2014年6~12月接受RARPN的21例患者的临床资料。患者年龄47~71岁,中位年龄57.2岁,体质指数(BMI)20.3~28.1kg/m2,中位数22.6kg/m2。其中左肾肿瘤9例,右肾肿瘤12例。肿瘤最大径2.5~5.4cm,中位数3.7cm。对术中估计失血量、热缺血时间、手术时间、术后切缘病理及术后并发症情况进行统计分析。结果:21例手术均成功完成,无一例中转开放手术。手术时间50~80min,平均65min,术中失血量70~150ml,平均90ml,均未输血;术中阻断肾动脉热缺血时间10~23min,平均16min;术后留置引流管2~4d,平均3d,拔除引流管后即可下床活动;术后病理均为透明细胞癌,其中Furhman分级Ⅱ级18例,Ⅱ~Ⅲ级3例,所有切除肿瘤均无阳性切缘。无严重术中、术后并发症发生。短期随访1~10个月,平均5个月,无死亡及疾病进展发生。结论:对于有机器人和后腹腔镜手术经验的外科医生来说,RARPN是安全可行的,该手术为可行肾部分切除术的患者提供了一种可选择的有效的微创方法。

Objective:To investigate the safety and feasibility of robot-assisted retroperitoneal laparoscopic par-tial nephrectomy (RARPN).Methods:A retrospective study on 21 RARPNs,from 2014 June to 2014 Dec,was per-formed in our hospital.The median age of these patients was 57.2 years old (47-71 years old),and the body mass index (BMI)was 22.6 kg/m2 (20.3-28.1 kg/m2 ).The left renal tumors were seen in 9 cases,and right in 12 cases. The median maximum tumor diameter was 3.7 cm (2.5-4.4 cm).The complications,estimated blood loss,warm ischemia time,operative time and positive margins were assessed.Results:All 21 cases were subjected to RARPNs successfully,and no cases were converted to open surgery.The operative time was 65 min (50-80 min),and esti-mated blood loss was 90 mL (70-1 50 mL).There was no blood transfusion.Median warm ischemia time was 1 6 min (10-23 min).Postoperative drainage time was 3 days (2-4 days).Pathologically postoperation,all cases were diag-nosed as having clear cell carcinoma,including 18 cases of Furhman grade Ⅱ,and 3 cases of grade Ⅱ-Ⅲ.No posi-tive margins were seem.No serious intraoperative,and postoperative complications occurred.During a short-term follow-up period (1 to 10 months),there were no death and disease progression.Conclusions:The RARPNis safe and feasible,and provides an alternative minimally invasive method for resection of renal cell carcinoma.