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目的:探讨机器人辅助腹腔镜下肾根治性切除加瘤栓取出术的安全性与可行性。方法:2014年10月~2015年10月采用机器人辅助腹腔镜下肾根治性切除加瘤栓取出术治疗肾癌合并静脉瘤栓患者5例,其中右肾肿瘤3例,左肾肿瘤2例;0级瘤栓2例,Ⅰ级瘤栓1例,Ⅱ级瘤栓2例。5例患者术前均行肾动脉栓塞及下腔静脉滤器置入,术前肿瘤无淋巴结转移及远处转移。结果:5例手术均获成功。手术时间114~226min,平均167min。术中2例肾静脉瘤栓未阻断下腔静脉,3例腔静脉瘤栓下腔静脉阻断时间分别为12 min、16 min、21min。术中出血量300~950ml,平均580ml。2例肾静脉瘤栓长度分别为5cm、6.3cm,3例腔静脉瘤栓长度分别为1cm、4.2cm和5cm。术后2~4天拔除腹腔引流管,6~8天出院。术后病理检查均诊断为透明细胞癌,其中Fuhrman分级Ⅱ级3例,Ⅱ~Ⅲ级1例,Ⅲ~Ⅳ级1例。随访4~6个月,患者病情无进展。结论:机器人辅助腹腔镜下肾根治性切除加瘤栓取出术具有安全性与可行性,但限于例数及随访时间有限,仍需后续更大样本、更长时间的研究与评价。
Objective: To investigate the safety and feasibility of robot assisted laparoscopic radical nephrectomy plus tumor embolization. Methods: From October 2014 to October 2015, 5 cases of renal cell carcinoma complicated with venous thrombus were treated with robotic assisted laparoscopic radical nephrectomy plus tumor embolization, including 3 cases of right kidney tumor and 2 cases of left kidney tumor. 0 grade tumor embolism in 2 cases, grade 1 tumor suppository in 1 case, grade Ⅱ tumor suppository in 2 cases. Five patients underwent preoperative renal artery embolization and inferior vena cava filter placement, preoperative tumor without lymph node metastasis and distant metastasis. Results: All the 5 surgeries were successful. Surgery time 114 ~ 226min, an average of 167min. Intraoperative 2 cases of renal vein tumor thrombus did not block the inferior vena cava, 3 cases of vena cava tumor caval vein occlusion time were 12 min, 16 min, 21 min. Intraoperative blood loss 300 ~ 950ml, an average of 580ml. 2 cases of renal vein tumor thrombus length were 5cm, 6.3cm, 3 cases of vena cava tumor thrombus length were 1cm, 4.2cm and 5cm. 2 to 4 days after removal of the abdominal drainage tube, 6 to 8 days discharged. Postoperative pathological examination were diagnosed as clear cell carcinoma, including Fuhrman grade Ⅱ 3 cases, Ⅱ ~ Ⅲ grade in 1 case, Ⅲ ~ Ⅳ grade in 1 case. Patients were followed up for 4 to 6 months without progression. Conclusions: Robotic assisted laparoscopic radical nephrectomy with tumor embolization is safe and feasible. However, limited to the number of cases and the limited follow-up, there is still a need for further studies and evaluations of larger samples and longer periods.