三维可视化技术在机器人保留肾单位手术中的应用

摘要

目的 探讨三维可视化技术在机器人辅助腹腔镜保留肾单位手术中的应用效果.方法 回顾性分析2018年1-12月我院行机器人辅助腹腔镜保留肾单位手术的98例肾肿瘤患者的临床资料.所有患者术前均完善肾脏CT检查,根据术前是否行三维可视化重建,将患者分为观察组(行三维可视化重建)和对照组(未行三维可视化重建).观察组41例,男20例,女21例;年龄(51.39±14.80)岁;体质指数(23.54±3.08) kg/m2;肿瘤位于左侧26例,右侧15例;肿瘤最大径中位值3.40 cm(1.90 ～8.30 cm);17、11、13例分别采用经腰、经腹和腰腹联合手术入路;术前R.E.N.A.L.评分(5.83±1.51)分.对照组57例,男35例,女22例;年龄(52.84±12.28)岁;体质指数(24.01±3.30) kg/m2;肿瘤位于左侧32例,右侧25例;肿瘤最大径中位值3.35 cm(1.40～7.00 cm);31、15、11例分别采用经腰、经腹和腰腹联合手术入路;术前R.E.N.A.L.评分(6.17±1.77)分.两组一般资料及手术人路选择方面的差异均无统计学意义(P＞0.05).比较两组手术情况及术后血红蛋白和肌酐变化情况等.结果 98例手术均顺利完成,未出现严重血管损伤和输尿管损伤并发症,无中转开放或更改手术方式.观察组热缺血时间较对照组显著缩短[中位值15.0 min (7.0～26.0 min)与20.0 min (10.0～28.0 min),P=O.02],差异有统计学意义.观察组与对照组手术时间差异无统计学意义[中位值130.0 min (65.0～340.0 min)与139.0 min(67.0～250.0 min),P=0.22].两组术后24h内血红蛋白下降值[中位值20.0 g/L(4.0～39.0 g/L)与15.5 g/L(2.0 ～40.0 g/L),P=0.56]和术后住院时间[中位值6.0d (4.0～ 14.0 d)与6.0d(5.0～14.0 d),P=0.86]差异无统计学意义.与术前相比,观察组与对照组术后24 h内肌酐上升值[中位值2.0 μmol/L(-10.0～ 28.0 μmol/L)与7.5 μmol/L(-17.0～51.0 μmol/L),P=0.24]和术后6个月肌酐上升值[中位值2.0μmol/L(-12.0～57.0 μmol/L)与4.5 μmol/L(-3.0～ 24.0 μ.mol/L),P=0.39]差异均无统计学意义.结论 术前完善三维可视化重建有助于缩短机器人辅助腹腔镜保留肾单位手术时的热缺血时间.%Objective To explore the potential value of applying three-dimensional visualization technology in the robot-assisted laparoscopic nephron sparing partial nephrectomy.Methods From January to December 2018,98 patients with renal carcinoma undergoing robot-assisted laparoscopic nephron sparing surgery were retrospectively analyzed.Forty-one patients in the experimental group accomplished kidney CT examination and three-dimensional reconstruction before surgery,and fifty-seven patients in the control group only completed kidney CT examination.There were 20 males and 21 females in the experimental group with the age of (51.39 ± 14.80) years and body mass index (BMI) of (23.54 ± 3.08) kg/m2.The median tumor diameter was 3.40 cm (range 1.90-8.30 cm) and the mean R.E.N.A.L.score was (5.83 ± 1.51) in the experimental group including 11 cases of transperitoneal,17 cases of retroperitoneal and 13 cases of combined transperitoneal and retroperitoneal access.There were 35 males and 22 females in the control group with the age of (52.84 ± 12.28) years and BMI of (24.01 ±3.30)kg/m2.The median tumor diameter was 3.35 cm (range 1.40-7.0 cm) and the mean R.E.N.A.L.score was (6.17 ± 1.77) in the control group including 15 cases of transperitoneal,31 cases of retroperitoneal and 11 cases of combined transperitoneal and retroperitoneal access.There was no statistical difference between two groups in term of age,gender,BMI score,R.E.N.A.L.score,tumor size,tumor location and operative approach.Results Ninety-eight cases of operation were successfully completed without causing vascular and ureteral injury.The warm ischemia time in the experimental group was significantly shorter than that of the control group [median 15.0 (7.0-26.0) min vs.20.0 (10.0-28.0) min,P--0.02],while no statistical difference was observed in term of operation time [median 130.0 (65.0-340.0) min vs.139.0 (67.0-250.0) min,P =0.22].There was no significant difference between the two groups in the decrease of hemoglobin within 24 hours after operation [median 20.0 (4.0-39.0) g/L vs.15.5 (2.0-40.0) g/L,P =0.56] and the average length of hospital stay after operation [median 6.0(4.0-14.0) d vs.6.0(5.0-14.0) d,P =0.86].The trend of creatinine declining was not statistically significant between the two groups at both 24 hours [median:2.0 (-10.0-28.0) μmol/L vs.7.5 (-17.0-51.0) μ mol/L,P =0.24] and 6 months after operation [median:2.0 (-12.0-57.0) μ mol/L vs.4.5 (-3.0-24.0) μmol/L,P =0.39].Conclusions Preoperative three-dimensional reconstruction is helpful to shorten the warm ischemia time,but it did not show short-term and long-term protection for renal function.