机器人辅助腹腔镜肾门部肿瘤切除术（65例报告）

摘要

Objective:To discuss the treatment and clinical experience of robot-assisted laparoscopic partial ne-phrectomy for renal hilar tumors.Methods:The clinical data of 740 cases receiving robot-assisted laparoscopic par-tial nephrectomy (RALPN)by 301st General Hospital from 2013 to 2016 were retrospectively reviewed.There were 65 cases of renal hilar tumors,including left and right hilar tumors of 39 and 26 (1.5∶1),respectively.The tumors were located on the front lip in 36 cases and the rear lip in 23 cases,and there were 6 cases of complete en-dophytic renal tumors.Results:All operations were completed successfully.The mean operative time was 137 (range:60-270)min,estimated blood loss was 64 (10-1 500)mL,warm ischemic time was 24.3 (10-118)min, and postoperative tube removal time was 3 (1-21)days.Pathologically,there were 51 cases of clear cell renal cell carcinoma (Furman nuclear grade Ⅰ-Ⅲ level),3 cases of papillary renal cell carcinoma,7 cases of angioleiomyoli-poma,2 cases of cystic renal cell carcinoma,1 case of oncocytoma,and 1 case of renal adenocarcinoma.Surgical margins were negative for malignancy in all cases.During a follow-up period of 1 to 9 6 months,there were no me-tastasis,deaths,recurrence,and leakage,etc.Conclusions:Robot-assisted laparoscopic partial nephrectomy for renal hilar tumor is a safe and effective operation.%目的：：探讨机器人辅助腹腔镜肾门部肿瘤切除术治疗效果及临床经验.方法：回顾性分析2008~2016年机器人辅助腹腔镜肾部分切除术740例患者资料,其中肾门部肿瘤65例.左肾肿瘤39例,右肾肿瘤26例,左右比1.5∶1.36例位于前唇、23例位于后唇、完全内生型6例.结果：65例手术均成功完成.手术时间：137 min(60~270 min,包含机器人安装时间),手术出血量：64 ml(10~1500 ml),肾动脉阻断时间：24.3 min(10~118 min),术后引流管拔除时间：3 d(1~21 d).病理回报：肾透明细胞癌51例(Furman 核分级Ⅰ~Ⅲ级),乳头状肾癌3例,血管平滑肌脂肪瘤7例,囊性肾癌2例,嗜酸性细胞瘤1例,肾腺癌1例.无切缘阳性病例.随访32.6个月(1~96个月),无转移、死亡、复发、漏尿等病例.结论：机器人辅助腹腔镜行肾门部肿瘤切除术安全、有效.