后腹腔镜、机器人腹腔镜、机器人后腹腔镜肾部分切除术的比较:单一术者经验
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摘要
目的比较机器人辅助腹腔镜肾部分切除术(robotic-assist laparoscopic partial nephrectomy,RALPN)、机器人辅助后腹腔镜肾部分切除术(robotic-assist retroperitoneal laparoscopic partial nephrectomy,RARPN)及传统后腹腔镜肾部分切除术(retroperitoneal laparoscopic partial nephrectomy,LPN)的疗效及安全性。方法回顾性分析2013年8月～2017年8月单一术者使用da Vinci机器人系统及Storz腹腔镜系统进行372例肾部分切除术的临床资料。其中RALPN 138例,RARPN 46例,LPN 188例。比较3组手术时间、术中失血量、肾动脉热缺血时间、术后并发症发生率及术后肿瘤复发转移率。结果 3组手术时间分别为(122.3±30.9)min、(112.5±28.7)min、(114.8±34.5)min,无统计学差异(F=2.682,P=0.070)。3组肾动脉阻断时间分别为(20.8±5.9)min、(19.4±5.1)min、(23.7±6.8)min(F=13.025,P=0.000),RALPN和RARPN明显短于LPN(P<0.05)。3组术中失血量分别为(89.0±76.9)ml、(42.9±40.3)ml、(55.2±86.6)ml(F=9.644,P=0.000),RALPN明显多于RARPN和LPN(P<0.05)。LPN组术中输血1例,RALPN及RARPN组均无术中输血。3组术后并发症发生率及术后肿瘤复发转移率无统计学差异(P>0.05)。结论机器人辅助腹腔镜手术及机器人辅助后腹腔镜手术均为安全、有效的手术方式。
Objective To compare the efficiency and safety among robotic-assist laparoscopic partial nephrectomy( RALPN),robotic-assist retroperitoneal laparoscopic partial nephrectomy( RARPN),and retroperitoneal laparoscopic partial nephrectomy( LPN). Methods A total of 372 patients,including 138 patients treated by RALPN,46 patients treated by RARPN and 188 patients treated by LPN,from August 2013 to August 2017 by the single surgeon with the da Vinci Robot Surgical System or the Storz laparoscopic surgical instruments were reviewed and analyzed. The operation time,blood loss volume,warm ischemia time,postoperative complication rate and recurrence or metastasis rate among the three groups were compared. Results The operation time was( 122. 3 ± 30. 9) min,( 112. 5 ± 28. 7) min,and( 114. 8 ± 34. 5) min,respectively,without statistic difference among the three groups( F = 2. 682,P = 0. 070). The warm ischemia time of the three groups was( 20. 8 ± 5. 9) min,( 19. 4 ± 5. 1) min,and( 23. 7 ± 6. 8) min,respectively,with statistic differences between RALPN or RARPN and LPN( F = 13. 025,P = 0. 000). The blood loss volume of the three groups was( 89. 0 ± 76. 9) ml,( 42. 9 ± 40. 3) ml,and( 55. 2 ± 86. 6) ml,respectively,with statistic differences between RALPN and RARPN or LPN( F = 9. 644,P = 0. 000). One case in LPN group received intraoperative blood transfusion and there was no case in the RALPN or RARPN groups. There was no statistic difference among the three groups on postoperative recurrence or metastasis rate( P > 0. 05). Conclusion Both RALPN and RARPN are safe and efficient operations.
Objective To compare the efficiency and safety among robotic-assist laparoscopic partial nephrectomy( RALPN),robotic-assist retroperitoneal laparoscopic partial nephrectomy( RARPN),and retroperitoneal laparoscopic partial nephrectomy( LPN). Methods A total of 372 patients,including 138 patients treated by RALPN,46 patients treated by RARPN and 188 patients treated by LPN,from August 2013 to August 2017 by the single surgeon with the da Vinci Robot Surgical System or the Storz laparoscopic surgical instruments were reviewed and analyzed. The operation time,blood loss volume,warm ischemia time,postoperative complication rate and recurrence or metastasis rate among the three groups were compared. Results The operation time was( 122. 3 ± 30. 9) min,( 112. 5 ± 28. 7) min,and( 114. 8 ± 34. 5) min,respectively,without statistic difference among the three groups( F = 2. 682,P = 0. 070). The warm ischemia time of the three groups was( 20. 8 ± 5. 9) min,( 19. 4 ± 5. 1) min,and( 23. 7 ± 6. 8) min,respectively,with statistic differences between RALPN or RARPN and LPN( F = 13. 025,P = 0. 000). The blood loss volume of the three groups was( 89. 0 ± 76. 9) ml,( 42. 9 ± 40. 3) ml,and( 55. 2 ± 86. 6) ml,respectively,with statistic differences between RALPN and RARPN or LPN( F = 9. 644,P = 0. 000). One case in LPN group received intraoperative blood transfusion and there was no case in the RALPN or RARPN groups. There was no statistic difference among the three groups on postoperative recurrence or metastasis rate( P > 0. 05). Conclusion Both RALPN and RARPN are safe and efficient operations.
引文
1罗光达,王昕凝,卢锦山,等.肾肿瘤临床特点和手术方式变化(单一术者945例报告).微创泌尿外科杂志,2017,6(3):140-143.
2 Mac Lennan S,Imamura M,Lapitan MC,et al.Systematic review of oncological outcomes following surgical management of localised renal cancer.Eur Uro,2012,61(5):972-993.
3 Patton MW,Salevitz DA,Tyson MD,et al.Robot-assisted partial nephrectomy for complex renal masses.J Robot Surg,2016,10(1):27-31.
4 吕香君,张旭,马鑫,等.经后腹腔与经腹腔入路机器人肾部分切除术的对照研究:单中心418例报告.中华泌尿外科杂志,2016,37(9):641-646.
5 Giedelman CA,Abdul-Muhsin H,Schatloff O,et al.The impact of robotic surgery in urology.Actas Urol Esp,2013,37(10):652-657.
6 Choi JE,You JH,Kim DK,et al.Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy:a systematic review and meta-analysis.Eur Urol,2015,67(5):891-901.
7 王昕凝,罗光达,刘圣圳,等.机器人辅助腹腔镜肾部分切除术:单一术者99例经验总结.中国微创外科杂志,2017,17(3):206-208,227.
8 Khalifeh A,Autorino R,Hillyer SP,et al.Comparative outcomes and assessment of trifecta in 500 robotic and laparoscopic partial nephrectomy cases:a single surgeon experience.J Urol,2013,189(4):1236-1242.
9 Miyake H,Furukawa J,Hinata N,et al.Significant impact of R.E.N.A.L.nephrometry score on changes in postoperative renal function early after robot-assisted partial nephrectomy.Int J Clin Oncol,2015,20(3):586-592.
10 Miyake H,Hinata N,Imai S,et al.Partial nephrectomy for hilar tumors:comparison of conventional open and robot-assisted approaches.Int J Clin Oncol,2015,20(4):808-813.
11 Long JA,Yakoubi R,Lee B,et al.Robotic versus laparoscopic partial nephrectomy for complex tumors:comparison of perioperative outcomes.Eur Urol,2012,61(6):1257-1262.
12 Kim DK,Komninos C,Kim L,et al.Robot-assisted partial nephrectomy for endophytic tumors.Curr Urol Rep,2015,16(11):76.
13 吴国辉,梁朝朝,周骏,等.机器人辅助、3D及传统腹腔镜在保留肾单位手术中的对比研究.中国内镜杂志,2015,21(11):1121-1125.
14 Yu HY,Hevelone ND,Lipsitz SR,et al.Use,costs and comparative effectiveness of robotic assisted,laparoscopic and open urological surgery.J Urol,2012,187(4):1392-1398.
15 罗光达,王昕凝,刘圣圳,等.机器人辅助腹腔镜肾门部肿瘤切除术(65例报告).微创泌尿外科杂志,2017,6(1):24-27.
16 Shiroki R,Fukami N,Fukaya K,et al.Robot-assisted partial nephrectomy:superiority over laparoscopic partial nephrectomy.Int J Urol,2016,23(2):122-131.
17 Luciani LG,Chiodini S,Donner D,et al.Early impact of robotassisted partial nephrectomy on renal function as assessed by renal scintigraphy.J Robot Surg,2016,10(2):123-128.
18 Lavery HJ,Small AC,Samadi DB,et al.Transition from laparoscopic to robotic partial nephrectomy:the learning curve for an experienced laparoscopic surgeon.JSLS,2011,15(3):291-297.
19 谢永鹏,马鑫,李宏召,等.机器人辅助腹腔镜肾部分切除术的学习曲线.微创泌尿外科杂志,2014,3(2):65-67.
20 Potretzke AM,Knight BA,Brockman JA,et al.The role of the assistant during robot-assisted partial nephrectomy:does experience matter.J Robot Surg,2016,10(2):129-134.
21 唐露,李新涛,吕香君,等.机器人手术助手对后腹腔入路机器人肾部分切除术围手术期的影响.微创泌尿外科杂志,2017,6(1):32-35.
2 Mac Lennan S,Imamura M,Lapitan MC,et al.Systematic review of oncological outcomes following surgical management of localised renal cancer.Eur Uro,2012,61(5):972-993.
3 Patton MW,Salevitz DA,Tyson MD,et al.Robot-assisted partial nephrectomy for complex renal masses.J Robot Surg,2016,10(1):27-31.
4 吕香君,张旭,马鑫,等.经后腹腔与经腹腔入路机器人肾部分切除术的对照研究:单中心418例报告.中华泌尿外科杂志,2016,37(9):641-646.
5 Giedelman CA,Abdul-Muhsin H,Schatloff O,et al.The impact of robotic surgery in urology.Actas Urol Esp,2013,37(10):652-657.
6 Choi JE,You JH,Kim DK,et al.Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy:a systematic review and meta-analysis.Eur Urol,2015,67(5):891-901.
7 王昕凝,罗光达,刘圣圳,等.机器人辅助腹腔镜肾部分切除术:单一术者99例经验总结.中国微创外科杂志,2017,17(3):206-208,227.
8 Khalifeh A,Autorino R,Hillyer SP,et al.Comparative outcomes and assessment of trifecta in 500 robotic and laparoscopic partial nephrectomy cases:a single surgeon experience.J Urol,2013,189(4):1236-1242.
9 Miyake H,Furukawa J,Hinata N,et al.Significant impact of R.E.N.A.L.nephrometry score on changes in postoperative renal function early after robot-assisted partial nephrectomy.Int J Clin Oncol,2015,20(3):586-592.
10 Miyake H,Hinata N,Imai S,et al.Partial nephrectomy for hilar tumors:comparison of conventional open and robot-assisted approaches.Int J Clin Oncol,2015,20(4):808-813.
11 Long JA,Yakoubi R,Lee B,et al.Robotic versus laparoscopic partial nephrectomy for complex tumors:comparison of perioperative outcomes.Eur Urol,2012,61(6):1257-1262.
12 Kim DK,Komninos C,Kim L,et al.Robot-assisted partial nephrectomy for endophytic tumors.Curr Urol Rep,2015,16(11):76.
13 吴国辉,梁朝朝,周骏,等.机器人辅助、3D及传统腹腔镜在保留肾单位手术中的对比研究.中国内镜杂志,2015,21(11):1121-1125.
14 Yu HY,Hevelone ND,Lipsitz SR,et al.Use,costs and comparative effectiveness of robotic assisted,laparoscopic and open urological surgery.J Urol,2012,187(4):1392-1398.
15 罗光达,王昕凝,刘圣圳,等.机器人辅助腹腔镜肾门部肿瘤切除术(65例报告).微创泌尿外科杂志,2017,6(1):24-27.
16 Shiroki R,Fukami N,Fukaya K,et al.Robot-assisted partial nephrectomy:superiority over laparoscopic partial nephrectomy.Int J Urol,2016,23(2):122-131.
17 Luciani LG,Chiodini S,Donner D,et al.Early impact of robotassisted partial nephrectomy on renal function as assessed by renal scintigraphy.J Robot Surg,2016,10(2):123-128.
18 Lavery HJ,Small AC,Samadi DB,et al.Transition from laparoscopic to robotic partial nephrectomy:the learning curve for an experienced laparoscopic surgeon.JSLS,2011,15(3):291-297.
19 谢永鹏,马鑫,李宏召,等.机器人辅助腹腔镜肾部分切除术的学习曲线.微创泌尿外科杂志,2014,3(2):65-67.
20 Potretzke AM,Knight BA,Brockman JA,et al.The role of the assistant during robot-assisted partial nephrectomy:does experience matter.J Robot Surg,2016,10(2):129-134.
21 唐露,李新涛,吕香君,等.机器人手术助手对后腹腔入路机器人肾部分切除术围手术期的影响.微创泌尿外科杂志,2017,6(1):32-35.