经腹腔机器人精准肾根治性切除术手术要点及应用体会

摘要

目的:探讨经腹腔途径机器人精准肾根治性切除术临床应用效果及其应用体会.方法:回顾分析2016年2月～2016年11月间由单一术者完成的24例经腹腔机器人辅助腹腔镜肾根治性切除术的临床资料,其中男20例,女4例,年龄22～73岁,平均55岁.手术采用4臂左侧5孔(右侧6孔)法,即1个镜头孔,3个操作孔,左侧1个(右侧2个)辅助孔,经过9个步骤的精细操作完成手术.对所有患者的术前、术中、术后资料进行统计分析并总结手术体会.结果:所有手术均顺利完成,无中转开腹.手术时间:80～184 min,平均(122.46±22.55) min;出血量:20～400 ml,平均65 ml,术中均未输血;术后平均住院时间(7.08±1.56)d;肿瘤位于左肾7例,右肾17例;肿瘤最大径2～7 cm,平均(4.40±1.20)cm.术后病理:透明细胞癌21例,嗜酸细胞腺瘤1例,乳头状肾细胞癌1例,Xp11.2易位/TF3融合基因相关性肾细胞癌1例.结论:将科学设计精细化的手术步骤应用于机器人肾根治性切除术具有手术时间短、术中出血少、术后并发症少、安全性高等优点,能缩短学习曲线,并为开展该手术的泌尿外科医生提供了有效的手术步骤参考.%Objective:To explore the clinical application and experience of precise robotic radical nephrectomy (RRN) through a transperitoneal approach.Methods:We retrospectively reviewed the records of patients who underwent RRN by the same surgeon at our institute from February 2016 to November 2016.Four robotic arms (one camera arm and three operation arms) were applied,and one assistant trocar was used for left kidney tumors as well as two for right ones.Twenty-four patients (20 males and 4 females) with a mean age of 55 (22-73) years old whose preoperative demographics,intraoperative parameters,postoperative parameters and complications were recorded and the operation experience was summarized.Results:All the operations were successfully completed with no convertion to open surgery.The mean operation time was (122.46±22.55) min (80-184 min).The mean blood loss was 65 (20-400) mL.The mean length of hospital stay was (7.08±1.56) d.Tumors in 7 eases were located in the left kidney and those in 17 cases in the right one.The mean maximum tumor diameter was (4.40± 1.20)cm (2-7 cm).Pathological results showed that there were 21 cases of clear cell carcinoma,1 case of oncocytoma,1 case of papillary renal cell carcinoma,and 1 case of Xp11.2 translocation/TF3 fusion gene-related renal cell carcinoma.Conclusions:The application of scientificly and precisely designed surgical procedures to the RRN has the advantage of shorter operation time,less blood loss,less postoperative complications and higher safety.It can shorten the learning curve and provide urologists an effective surgical procedure for reference.