摘要
目的总结机器人辅助腹腔镜下肾部分切除术的手术经验，探讨该术式的疗效及安全性。方法2012年3—7月实施机器人辅助腹腔镜下肾部分切除术12例。患者均为男性。年龄43～66岁，平均55岁。肿瘤位于左肾4例，右肾8例；背侧7例，腹侧2例；上极3例，中部5例，下极4例。术前常规行肾GFR检查均正常。CT检查肿瘤最大径2．0～5．8cm，平均3．3cm。术前分期均为T1N0M0。结果本组手术均成功完成，无中转开放手术者。手术时间160～310min，平均242min；术中失血量30～300ml，平均135ml，无术中输血；热缺血时间20-49min，平均31min；无术中并发症。住院天数9—31d，平均14d。1例术后1周出现肉眼血尿。术后病理检查11例为肾透明细胞癌，Furhman分级均为Ⅱ级，1例为肾血管平滑肌脂肪瘤。肿瘤最大径2．0～5．0cm，平均3．5cm，肿瘤切缘均为阴性。结论机器人辅助腹腔镜下肾部分切除术是一种安全、有效的治疗局限性肾肿瘤的术式。该术式在肾肿瘤的完整切除及肾脏创面的缝合上有明显的优势。
Objective To summarize the surgical experience in robotic-assisted laparoscopic partial nephrectomy, and to investigate the efficacy and safety of this surgery. Methods The clinical data of 12 patients who underwent robot-assisted laparoscopie partial nephrectomy in Changhai Hospital from March to July in 2012 were analyzed. All the patients were male and the age range was 43 -66 years. In 4 cases the tumors were in the left kidney, and 8 in the right. In 7 cases the tumors were in the dorsal part of the kid- ney, and 2 in the ventral part. There were 3, 5 and 4 cases in the upper, middle and lower pole of the kid- ney respectively. Preoperative GFR test was normal in all cases. Kidney CT scan showed the maximum di- ameters of the tumors were 2.0 - 5.8 cm, with an average of 3.3 cm. The pre-operative stages in all cases were T1N0M0. Results The surgery was successfully completed in all cases. The mean duration of the surgery was 160 -310 min, with an average of 242 min. The blood loss was 30 -300 ml, with an average of 135 ml, and the intraoperative blood transfusion was unnecessary. The warm isehemia time was 20 -49 min, with an average of 31 min. There was no intraoperative morbidity, and no conversion to open surgery. The postoperative length of hospitalization was 9 -31 d, with an average of 14 d. Gross hematuria arose in 1 pa- tient at 1 week after the surgery. The post-operative pathology showed renal clear cell carcinoma with Furhman Grade II in 11 cases, and renal angiomyolipoma in 1 case. The maximum diameters of the tumors were 2.0 - 5.0 cm, with an average of 3.5 cm. The tumor resection margin was negative in all cases. Conclusions Robot-assisted laparoscopic partial nephrectomy is safe and effective for local renal tumors. This surgery has significant advantage over traditional laparoscopic partial nephrectomy, in terms of the re- section of the renal tumors and the reconstruction of the kidney.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2012年第11期814-817,共4页
Chinese Journal of Urology
关键词
机器人
外科手术
微创性
腹腔镜检查
肾部分切除术
Robotics
Surgical procedures, minimally invasive
Laparoscopy
Partial ne- phrectomy
