经后腹腔途径行机器人辅助腹腔镜与传统腹腔镜下肾部分切除术的比较研究

摘要

目的：：总结经后腹腔途径行机器人辅助腹腔镜与传统腹腔镜下手术切术肾肿瘤的手术治疗经验,探讨机器人辅助腹腔镜的疗效及优势.方法：2012年5月~2013年8月,收治3例肾肿瘤患者进行机器人辅助腹腔镜下肾部分切除术(RALPN),同期选取3例行传统腹腔镜下手术切术(LPN)肾肿瘤的患者资料进行分析.结果：6例手术均取得成功.其中RALPN术3例手术时间(不包括术前机器人准备时间)110~180 min(平均145 min),出血量50~100 ml,术后2~3天拔除引流管,3天左右下床活动,术后住院时间8~10天.术后2周复查未见局部病灶残留,肾功能与术前无明显变化.3例行LPN术手术时间为120~200 min(平均160 min),出血量80~150 ml,术后3~4天拔除引流管,4~5天下床活动,术后住院时间9~12天.术后2周复查未见局部病灶残留,肾功能与术前无明显变化.结论：RALPN在手术出血及术后患者恢复等方面与LPN相比更具一定优势,手术效率更高,操作灵活,创伤小,疗效确切.%Objective:To compare the treatment experience between conventional laparoscopy with robot-assisted laparosco-py (da Vinci Si System)for partial nephrectomy through retroperitoneal approach,and discuss curative effect and advantages of robotic system.Methods:Between May 2012 and August 2013,3 patients with renal tumor were performed robotic-assisted la-proscopic partial nephrectomy(RALPN).During the same period,3 patients with renal tumor were performed conventional lap-aroscopic partial nephrectomy(LPN).Results:All procedures were performed successfully.The operative time for RALPN was 110-180 minutes (mean 145 minutes);blood loss was 50-100 mL,drain removal time was 2-3 days.The hospital stay was 8-10 days with 3 days of immobilization.Radiological examination found no local residual tumor,and the postoperative serum creati-nine level was norma1 two weeks after operation.The operative time for conventional LPN was 120-200 minutes (mean 160 mi-nutes);blood loss was 80-150 mL,drain removal time was 3-4 days.The hospital stay was 9-12 days with 4-5 days of immobi-lization.Radiological examination found no local residual tumor,and the postoperative serum creatinine level was norma1 two weeks after operation.Conclusions:RALPN through retroperitoneal approach could reduce the suturing time and blood loss and has the merits of small wound and early recovery than conventional LPN.