机器人辅助腹腔镜与腹腔镜保留肾单位手术治疗肾门唇部肿瘤的临床对比分析
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摘要
目的:探讨机器人辅助腹腔镜与传统腹腔镜对肾门唇部肿瘤行保留肾单位手术的临床疗效对比及手术经验。方法:回顾性分析2016年1月～2018年8月我院行保留肾单位微创手术治疗的68例肾门唇部肿瘤患者的临床资料,其中前唇肿瘤45例,后唇肿瘤23例。肿瘤直径1.5～8.0cm,平均4.2cm。行机器人手术38例(机器人组),腹腔镜手术30例(腹腔镜组)。结果:68例手术均顺利进行,平均手术时间93min(60～180min,不包含机器人装机时间),平均肾动脉阻断时间21.6(7～44)min,平均术中出血量156(20～600)ml,平均术后引流管拔除时间4(3～6)d,平均术后住院5.3(4～9)d,未出现明显术后并发症。中位随访13.5(3～32)个月,无复发、转移、死亡病例。与腹腔镜相比,机器人手术可明显减少手术时间(P<0.001)和术中出血量(P=0.011);机器人组与腹腔镜组肾动脉阻断时间分别为(19.0±6.5)min和(25.0±7.4)min(P=0.001),住院费用分别为(5.2±0.4)万元和(3.7±0.4)万元(P<0.001)。结论:肾门肿瘤采用微创保留肾单位手术进行治疗是安全可行的。与传统腹腔镜相比,机器人手术的住院费用增加,但对于治疗肾门肿瘤优势明显,可以显著缩短热缺血时间,减少术中出血量,使患者得到最大程度的获益。
Objective:To compare the operative-postoperative outcomes between robot-assisted laparoscopic and laparoscopic partial nephrectomy(RALPN and LPN)for patients with renal hilar tumor.Method:A total of68 renal hilar tumor patients receiving RALPN(n=38)or LPN(n=30)in our center between January 2016 and August 2018 were retrospectively collected.The tumors were located on the front lip in 45 cases and the rear lip in23 cases.The mean tumor size was 4.2(range,1.5-8.0)cm.Result:All operations were completed successfully.The mean operative time was 93(range,60-180)min,estimated blood loss was 156(range,20-600)ml,warm ischemic time was 21.6(range,7-44)min,postoperative tube removal time was 4(range,3-6)days and postoperative hospital stay was 5.3(range,4-9)days.There was no obvious postoperative complication.During a median follow-up period of 13.5 months,there was no recurrence,metastasis or death.Compared with LPN group,operative time and estimated blood loss were significantly reduced in RALPN group.There was significant difference in warm ischemia time[(19.0±6.5)min vs.(25.0±7.4)min,P=0.001]and hospitalization cost[(5.2±0.4)ten-thousand Yuan vs.(3.7±0.4)ten-thousand Yuan,P <0.001]between the RALPN and the LPN group.Conclusion:Minimally invasive surgery for renal hilar tumor is safe and feasible.Compared with LPN,RALPN has higher hospitalization costs,but it has obvious advantages in the treatment of renal hilar tumor,which can significantly shorten the warm ischemia time,reduce intraoperative bleeding and maximize the benefits of patients.
Objective:To compare the operative-postoperative outcomes between robot-assisted laparoscopic and laparoscopic partial nephrectomy(RALPN and LPN)for patients with renal hilar tumor.Method:A total of68 renal hilar tumor patients receiving RALPN(n=38)or LPN(n=30)in our center between January 2016 and August 2018 were retrospectively collected.The tumors were located on the front lip in 45 cases and the rear lip in23 cases.The mean tumor size was 4.2(range,1.5-8.0)cm.Result:All operations were completed successfully.The mean operative time was 93(range,60-180)min,estimated blood loss was 156(range,20-600)ml,warm ischemic time was 21.6(range,7-44)min,postoperative tube removal time was 4(range,3-6)days and postoperative hospital stay was 5.3(range,4-9)days.There was no obvious postoperative complication.During a median follow-up period of 13.5 months,there was no recurrence,metastasis or death.Compared with LPN group,operative time and estimated blood loss were significantly reduced in RALPN group.There was significant difference in warm ischemia time[(19.0±6.5)min vs.(25.0±7.4)min,P=0.001]and hospitalization cost[(5.2±0.4)ten-thousand Yuan vs.(3.7±0.4)ten-thousand Yuan,P <0.001]between the RALPN and the LPN group.Conclusion:Minimally invasive surgery for renal hilar tumor is safe and feasible.Compared with LPN,RALPN has higher hospitalization costs,but it has obvious advantages in the treatment of renal hilar tumor,which can significantly shorten the warm ischemia time,reduce intraoperative bleeding and maximize the benefits of patients.
引文
1张旭.泌尿外科腹腔镜手术学[M].北京:人民卫生出版社,2008:74-84.
2 Capitanio U,Terrone C,Antonelli A,et al.Nephronsparing techniques independently decrease the risk of cardiovascular events relative to radical nephrectomy in patients with a T1a-T1brenal mass and normal preoperative renal function[J].Eur Urol,2015,67(4):683-689.
3 Gill I S,Colombo J R Jr,Frank I,et al.Laparoscopic partial nephrectomy for hilar tumors[J].J Urol,2005,174(3):850-854.
4 Reisiger K,Venkatesh R,Figenshau R S,et al.Complex laparoscopic partial nephrectomy for renal hilar tumors[J].Urology,2005,65(5):888-891.
5 Lattouf J B,Beri A,DAmbros O F,et al.Laparoscopic partial nephrectomy for hilar tumors:technique and results[J].Eur Urol,2008,54(2):409-416.
6刘可,王国良,黄毅,等.腹腔镜肾部分切除术治疗复杂肾门肿瘤[J].北京大学学报(医学版),2012,44(4):649-651.
7袁建林,孟平,杨晓剑,等.经腹腔和后腹腔入路机器人辅助腹腔镜下肾部分切除术治疗肾门肿瘤的临床研究[J].中华泌尿外科杂志,2017,28(7):502-506.
8葛光炬,丁国庆,赵伟平,等.机器人辅助腹腔镜下肾部分切除术治疗肾门部肿瘤22例临床观察[J].中华医学杂志,2018,98(30):2438-2440.
9 Marszalek M,Chromecki T,Al-Ali B M,et al.Laparoscopic partial nephrectomy:a matched-pair comparison of the transperitoneal versus the retroperitoneal approach[J].Urology,2011,77(1):109-113.
10 Ng C S,Gill I S,Ramani A P,et al.Transperitoneal versus retroperitoneal laparoscopic partial nephrectomy:patient selection and perioperative outcomes[J].J Urol,2005,174(3):846-849.
11周晓晨,刘伟鹏,张成,等.机器人辅助经腹膜后腔入路超薄肾实质层肾部分切除术的经验介绍(附58例报告)[J].临床泌尿外科杂志,2017,32(8):580-584.
2 Capitanio U,Terrone C,Antonelli A,et al.Nephronsparing techniques independently decrease the risk of cardiovascular events relative to radical nephrectomy in patients with a T1a-T1brenal mass and normal preoperative renal function[J].Eur Urol,2015,67(4):683-689.
3 Gill I S,Colombo J R Jr,Frank I,et al.Laparoscopic partial nephrectomy for hilar tumors[J].J Urol,2005,174(3):850-854.
4 Reisiger K,Venkatesh R,Figenshau R S,et al.Complex laparoscopic partial nephrectomy for renal hilar tumors[J].Urology,2005,65(5):888-891.
5 Lattouf J B,Beri A,DAmbros O F,et al.Laparoscopic partial nephrectomy for hilar tumors:technique and results[J].Eur Urol,2008,54(2):409-416.
6刘可,王国良,黄毅,等.腹腔镜肾部分切除术治疗复杂肾门肿瘤[J].北京大学学报(医学版),2012,44(4):649-651.
7袁建林,孟平,杨晓剑,等.经腹腔和后腹腔入路机器人辅助腹腔镜下肾部分切除术治疗肾门肿瘤的临床研究[J].中华泌尿外科杂志,2017,28(7):502-506.
8葛光炬,丁国庆,赵伟平,等.机器人辅助腹腔镜下肾部分切除术治疗肾门部肿瘤22例临床观察[J].中华医学杂志,2018,98(30):2438-2440.
9 Marszalek M,Chromecki T,Al-Ali B M,et al.Laparoscopic partial nephrectomy:a matched-pair comparison of the transperitoneal versus the retroperitoneal approach[J].Urology,2011,77(1):109-113.
10 Ng C S,Gill I S,Ramani A P,et al.Transperitoneal versus retroperitoneal laparoscopic partial nephrectomy:patient selection and perioperative outcomes[J].J Urol,2005,174(3):846-849.
11周晓晨,刘伟鹏,张成,等.机器人辅助经腹膜后腔入路超薄肾实质层肾部分切除术的经验介绍(附58例报告)[J].临床泌尿外科杂志,2017,32(8):580-584.