机器人辅助腹腔镜技术治疗单侧多发肾肿瘤的诊疗分析

摘要

Objective:By summarizing the clinical data of robot-assisted laparoscopic technique for the treat-ment of unilateral multifocal renal tumors,to evaluate the safety and feasibility of this technique and improve the treatment level of this disease.Methods:Clinical data and prognostic information of 22 patients who were admitted to PLA General Hospital from November 2013 to April 2016 with the application of robot-assisted laparoscopic technique for the treatment of unilateral multifocal renal tumors were retrospectively analyzed.Results:All the 22 operations were successfully performed,and 4 cases were given radical nephrectomy because of high grade classifi-cations.This study included 21 males and 1 female with a mean age of 50.3 years old,11 patients with more than 2 tumor lesions,and 6 patients with the history of radical nephrectomy for the reason of renal tumor.The pre-op-erative creatinine was (94.83±19.73)μmoL/L,the post-operative creatinine 3 months after surgery was (146.10 ±54.79)μmoL/L,the warm ischemia time was (30.08±17.50)min,the estimated blood loss was (222.7± 306.5)mL,the postoperative hospital stay was (6.9±2.9)days,and the postoperative fasting days were (1.9± 0.8)days.Seventeen patients were undergone transperitoneal approach,5 patients were undergone retroperitoneal approach,and 6 patients were undergone robot-assisted laparoscopic renal artery cold perfusion surgery.The patho logical diagnosis confirmed that there were 2 1 cases of clear cell renal cell carcinoma and 1 case of papillary renal cell carcinoma,and no positive margin and lymph node metastasis was found.No recurrence or metastasis was observed during a follow-up period of 3 to 37 months.Conclusions:Robot-assisted laparoscopic technique for the treatment of unilateral multifocal renal tumors is safe and feasible,and its short-term tumor control and renal function reservation are satisfactory.However,further larger-scale researches with longer follow-up period were required.%目的：：总结机器人辅助腹腔镜技术治疗单侧多发肾肿瘤的资料,评价手术安全性和可行性,提高治疗水平.方法：回顾性分析2013年11月~2016年4月采用机器人辅助腹腔镜手术治疗的22例单侧多发肾肿瘤患者的临床资料和预后信息.结果：22例手术均获得成功,其中4例因分级较高而采用根治性切除术.22例患者中,男21例,女1例,平均50.3岁.11例患者肿瘤病灶大于2个,6例患者术前有另一侧肾癌根治手术史.术前肌酐(94.83±19.73)μmol/L,术后3个月肌酐(146.10±54.79)μmol/L,温缺血(30.08±17.50)min,术中出血(222.7±306.5)ml,术后住院(6.9±2.9)d,术后禁食(1.9±0.8)d.17例经腹腔手术入路,5例经后腹腔手术入路；6例行肾动脉低温灌注机器人辅助腹腔镜肾部分切除术.术后病理：21例为透明细胞癌,1例乳头状细胞癌.所有患者均无切缘阳性及淋巴结转移,术后随访8~37个月,均未出现复发及转移.结论：机器人辅助腹腔镜治疗单侧多发肾肿瘤是安全、可行、有效的方法.近期肿瘤控制效果满意,远期疗效有待大样本研究.