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目的总结机器人辅助腹腔镜下单纯肾肿瘤剜除术的手术经验,并初步探讨此术式的临床疗效。方法回顾性分析2014年11月至2015年6月于南京大学医学院附属鼓楼医院接受机器人辅助腹腔镜下肾肿瘤剜除术的66例患者,其中男43例、女23例,平均年龄(55±11)岁。本组共66个肿瘤,其中左肾41例、右肾25例。根据R.E.N.A.L评分:低度复杂(4~6分)3例、中度复杂(7~9分)42例、高度复杂(10~12分)21例。所有肿瘤患者均经术前CT及超声证实,排除集合系统侵犯或者远处转移,肿瘤平均直径(4.6±1.2)cm,临床分期为T_(1a)N_0M_0-T_(2a)N_0M_0。术前平均血红蛋白(Hb)为(131±18)g/L、平均血清肌酐(SCr)为(93±37)μmol/L、患肾平均肾小球滤过率(GFR)为(39±8)ml/min。结果 66例患者均手术成功,无中转开放。手术平均时间(160±35)min,本组57例患者实施肾动脉阻断,平均热缺血时间(19±5)min,平均出血量(149±36)ml,术中未输血。术后1周无继发出血、漏尿等并发症发生。术后3 d复查Hb(124±12)g/L、SCr(97±32)μmol/L、患肾GFR(37±9)ml/min,与术前比较差异均无统计学意义(P>0.05)。术后病理示:肿瘤切缘阳性率1.5%,肾良性病变8例,肾癌58例。术后平均随访(6.7±1.2)个月,未见肿瘤复发及新发慢性肾功能不全等并发症。结论机器人辅助肾肿瘤剜除术是安全的,短期随访研究证实肿瘤控制效果满意,且对肾功能影响较小。
Objective To summarize the surgical experience of robot-assisted laparoscopic surgery for simplex nephrectomy and to investigate the clinical efficacy of this technique. Methods A retrospective analysis was performed on 66 patients who underwent robotic laparoscopic nephroureterectomy at Drum Tower Hospital, Nanjing University Medical College from November 2014 to June 2015. There were 43 males and 23 females with an average age of 55 ± 11) years old. This group a total of 66 tumors, of which 41 cases of left kidney, 25 cases of right kidney. According to R.E.N.A.L score: low complexity (4 to 6) in 3 cases, moderately complicated (7 to 9 points) in 42 cases and highly complicated (10 to 12 points) in 21 cases. All tumor patients were confirmed by preoperative CT and ultrasonography, excluding agglutination of the collection system or distant metastasis. The mean tumor diameter was (4.6 ± 1.2) cm and the clinical stage was T 1a (N_0M_0-T_ (2a) N_0M_0). The preoperative mean hemoglobin (Hb) was (131 ± 18) g / L, the average serum creatinine (SCr) was (93 ± 37) μmol / L and the mean GFR was (39 ± 8) ) ml / min. Results All the 66 patients were successfully operated and did not transit to open. The average time of operation was (160 ± 35) min. 57 patients underwent renal artery occlusion, the average time of warm ischemia was (19 ± 5) min and the average amount of bleeding was (149 ± 36) ml. One week after operation, no secondary bleeding, leakage of urine and other complications occurred. There were no significant differences in Hb (124 ± 12) g / L, SCr (97 ± 32) μmol / L and GFR (37 ± 9) ml / 0.05). Postoperative pathology showed: the positive rate of tumor margin of 1.5%, 8 cases of benign nephropathy, kidney cancer in 58 cases. After an average follow-up of (6.7 ± 1.2) months, no complications such as tumor recurrence and new-onset chronic renal insufficiency were observed. Conclusions Robot assisted nephrectomy is safe, and short-term follow-up studies have demonstrated satisfactory tumor control and less effect on renal function.