摘要
目的总结达芬奇机器人辅助腹腔镜肾部分切除术治疗PADUA评分≥10分肾肿瘤的手术疗效,评估其安全性、可行性,探讨其潜在的临床应用价值。方法通过分析2012年5月至2013年9月长海医院同一术者完成的37例机器人辅助腹腔镜肾部分切除术治疗PADUA评分≥10分肾脏肿瘤患者资料,总结临床经验,评价手术疗效。本组患者男性21例,女性16例,年龄32-72岁,平均(52.3±10.1)岁;体质指数(BMI)平均24.9±3.88(17.1-34.3)kg/m2;Charlson全身合并症评分(Age-weighted)平均0.5±0.84(0-3);肿瘤侧别(左/右)20/17,均为单侧单发肿瘤;最大径平均4.2±1.19(2.1-7.2)cm,肾肿瘤PADUA评分平均10.8±0.87(10-13),术前肾小球滤过率估计值(estimated glomerular filtration rate,eGFR)平均101.2±25.58(46.6-198.7)mL/(min·1.73m2)。腔镜下分离肾动静脉、肾周及肿瘤后,阻断肾蒂或不阻断肾蒂,切除肿瘤,缝合重建。结果37例患者手术均顺利完成,无中转手术,无任何术中并发症,无术中输血,手术时间平均241±50.0(120-330)min,术中出血量平均185±169.9(50-1000)mL。肾脏缺血时间平均26.7±9.90(0-50)min。术后住院时间平均11.3±3.38(7-23)d。术后并发症发生率13.5%(5/37)。病理学检查提示:手术切缘均为阴性,透明细胞癌28例,嫌色细胞癌3例,乳头状细胞癌1例,血管平滑肌脂肪瘤等肾脏良性病变5例。术后随访时间平均5.9±4.64(1-12)个月,37例患者均存活,未发现局部复发或远处转移,eGFR平均下降8%,与术前相比差异有统计学意义(P=0.004)。结论对于高PADUA评分的复杂肾肿瘤,达芬奇机器人辅助腹腔镜肾部分切除术微创效果好、操作精细、安全性高,肾功能损害小,但肿瘤控制效果需进一步随访观察。
Objective To evaluate the safety,feasibility and efficacy of da Vinci robot-assisted laparoscopic partial nephrectomy in treating renal tumors with PADUA score≥10,so as to discuss its clinical potential.Methods Between May 2012 and September 2013,da Vinci robot-assisted laparoscopic partial nephrectomy was performed for 37 renal tumors withPADUA score≥10 by a single urologist in our institution.The information of the patients were:age 52.3±10.1(32-72)years old;body mass index 24.9±3.88(17.1-34.3)kg/m2;Charlson Co-morbidity Index(Age-weighted)0.5±0.84(0-3);and tumor laterality(L/R)20/17.The tumors were unilateral and solitary lesions,with a mean diameter of 4.2±1.19(2.1-7.2)cm,a PADUA score of 10.8±0.87(10-13),and a preoperative estimated glomerular filtration rate(eGFR)of 101.2±25.58(46.6-198.7)mL/(min·1.73m2).The renal arteries veins,and renal surroundings were isolated and the tumors were excised with or without blocking renal pedicle;all these procedures together with renorrhaphy were done by da Vinci robot-assisted laparoscopic techniques.Results All the 37 cases were smoothly done without surgical conversion,intraoperative complications or transfusion.The mean operative time was 241±50.0(120-330)min,estimated blood loss was 185±169.9(50-1000)mL,and renal ischemia time was 26.7±9.90(0-50)min.The mean postoperative hospital stay was 11.4±3.44(8-19)days,with an overall complication rate of 13.5%(5/37).Pathological examination revealed no positive surgical margin,and there were 28 cases of renal clear cell carcinoma,3 papillary cell carcinoma,and 5different types of benign lesions.All the patients were alive during a mean follow-up of 5.9±4.64(1-12)months,with no local recurrence or distant metastasis.Nevertheless,eGFR was decreased by a mean of 8%,showing significant difference compared with that before operation(Z=-2.883,P=0.004).Conclusion For high PADUA score renal tumors,da Vinci robot-assisted laparoscopic partial nephrectomy has the advantages of minimal invasiveness,better safety,fine manipulation,and renal function preservation,although the cancer control outcome awaits further follow-up.
作者
叶华茂
王蓉
吴震杰
李明敏
蔡晨
吕晨
王林辉
孙颖浩
YE Hua-mao;WANG Rong;WU Zhen-jie;LI Ming-min;CAI Chen;LÜChen;WANG Lin-hui;SUN Ying-hao(Department of Urology,Changhai Hospital,Second Military Medical University,Shanghai 200433,China;Department of Surgery(IⅢ),Seventh Peopele's Hospital of Shanghai,Shanghai 200137,China;Department of Radiology,Changhai Hospital,Second Military Medical University,Shanghai 200433,China;Department of Special Clinics,Changhai Hospital,Second Military Medical University,Shanghai 200433,China)
出处
《第二军医大学学报》
CAS
CSCD
北大核心
2014年第7期800-803,共4页
Academic Journal of Second Military Medical University
基金
国家自然科学基金面上项目(81272817)
上海市卫生系统优秀人才培养计划项目(XBR2011027)
上海市科技人才计划项目(13XD1400100)
上海市"领军人才"计划项目(2013046
WLH)
长海医院"1255"学科建设计划项目(CH125520300)
浦东新区卫生系统优秀青年医学人才培养项目(PWRq2012-11)
