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目的:探讨机器人辅助腹腔镜下肾部分切除术(robot-assisted laparoscopic partial nephrectomy,RAPN)的安全性与有效性。方法:回顾性分析2015年5月~2016年9月22例行RAPN患者的临床资料。男10例,女12例。年龄27~72岁,平均(47.6±12.5)岁。肾肿瘤位于左侧11例,右侧11例。肿瘤最大径2.3~12.8cm,平均(4.0±2.2)cm。复杂性肾肿瘤9例,其中完全内生型肿瘤1例,大肿瘤(直径>7cm)4例,肾门部肿瘤4例。结果:经腹入路20例,经腹膜后入路2例。22例均获成功,无中转开放。手术时间90~420min,平均(191.6±69.9)min;术中失血量10~800ml,平均(180.2±250.0)ml;热缺血时间(warm ischemia time,WIT)9~30min,平均(24.4±9.3)min。术后留置引流管2~7d,平均(4.2±1.4)d;术后住院时间5~14d,平均(8.5±1.9)d。术前肌酐(80.0±23.4)μmol/L,术后肌酐(81.2±31.3)μmol/L。术后病理:肾透明细胞癌11例,肾错构瘤7例,乳头状肾细胞癌2例,多房囊性肾细胞癌1例,嫌色细胞癌1例;无切缘阳性。术后出血1例,行剖腹探查,缝合止血后痊愈。随访4~20个月,无局部复发、转移和死亡发生。结论:RAPN安全有效,在肾肿瘤的完整切除和创面缝合上有明显的优势,尤其在处理复杂肾肿瘤中优势明显。
Objective: To investigate the safety and effectiveness of robotic-assisted laparoscopic partial nephrectomy (RAPN). Methods: The clinical data of RAPN patients from May 2015 to September 2016 were analyzed retrospectively. 10 males and 12 females. Age 27 to 72 years, mean (47.6 ± 12.5) years. Kidney tumors were located on the left side in 11 cases and on the right side in 11 cases. The largest diameter of tumor ranged from 2.3 to 12.8 cm, with an average of (4.0 ± 2.2) cm. 9 cases of complex renal tumors, including 1 case of complete endometrial tumor, 4 cases of large tumor (diameter> 7cm) and 4 cases of renal tumor. Results: Transabdominal approach in 20 cases, 2 cases of retroperitoneal approach. 22 cases were successful, no transit open. The mean operative time was 90 ~ 420min (mean, 191.6 ± 69.9) min. The intraoperative blood loss was 10 ~ 800ml (average 180.2 ± 250.0) ml. The warm ischemia time (WIT) ) min. Postoperative indwelling drainage tube 2 ~ 7d, an average of (4.2 ± 1.4) d; postoperative hospital stay 5 ~ 14d, an average of (8.5 ± 1.9) d. Preoperative creatinine (80.0 ± 23.4) μmol / L, postoperative creatinine (81.2 ± 31.3) μmol / L. Postoperative pathology: renal clear cell carcinoma in 11 cases, renal hamartoma in 7 cases, papillary renal cell carcinoma in 2 cases, 1 case of multilocular renal cell carcinoma, chromophobe carcinoma in 1 case; no positive margins. Postoperative bleeding in 1 case, laparotomy exploration, suture hemostasis recovered. Follow-up 4 to 20 months, no local recurrence, metastasis and death occurred. Conclusion: RAPN is safe and effective. It has obvious advantages in complete resection of renal tumor and wound suture, especially in the treatment of complex renal tumors.