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目的:总结单中心经腹机器人辅助腹腔镜下行巨大肾癌(肿瘤直径≥7cm)根治术的手术经验,探讨该技术的疗效及安全性。方法:回顾分析2008年10月~2015年4月应用达芬奇机器人辅助腹腔镜完成巨大肾癌根治性切除术29例的临床资料,总结巨大肾癌临床特点、手术经验、手术时间、术中并发症、术中出血量、术后住院时间等。结果:2008年10月~2015年4月共有101例行肾癌根治性切除,其中29例为巨大肾癌(占根治性肾切除的28.71%)。其临床特点为:男20例,女9例,平均(54.9±11.9)岁;左侧14例,右侧15例;肿瘤最大直径16cm,平均(9.56±2.36)cm;11例(39.29%)合并癌栓形成。29例均经腹腔途径完成,无中转开放;合并癌栓11例病例术前均行介入肾动脉栓塞;手术时间(164.4±40.0)min;术中出血量50~1 200ml。术后胃肠功能平均恢复(2.65±0.71)d;引流管拔除平均时间(3.17±1.36)d;术后平均住院(6.8±2.5)d。本组术中无十二指肠、肝脏、结肠及大血管损伤,术后无腹腔感染及术后肠梗阻。术后病理分期,T2N0~1M0~1期9例,T3N0~1M0~1期14例,T4N0~1M0~1期6例。随访1~24个月,肾床肿瘤复发或远处转移8例(27.6%)。结论:根据初期的手术操作经验和随访结果,经腹机器人辅助腹腔镜下行巨大肾癌根治术是安全和可行的,长期和前瞻性的对照研究将有助于对这一技术的评估。
OBJECTIVE: To summarize the surgical experience of single-center abdominal robotic-assisted laparoscopic radical nephrectomy for the treatment of giant renal cell carcinoma (tumor diameter> = 7 cm) to investigate the efficacy and safety of this technique. Methods: The clinical data of 29 cases with giant renal cell carcinoma undergoing laparoscopic radical nephrectomy with Da Vinci robot assisted laparoscopy were retrospectively analyzed. The clinical features, operation experience, operation time, Complications, intraoperative blood loss, postoperative hospital stay and so on. Results: From October 2008 to April 2015, there were 101 cases of radical resection of renal cell carcinoma, of which 29 cases were giant renal cell carcinoma (28.71% of radical nephrectomy). The clinical features were 20 males and 9 females, with an average of (54.9 ± 11.9) years; 14 on the left and 15 on the right; the largest diameter of the tumor was 16 cm (average 9.56 ± 2.36 cm); 11 (39.29% Combined tumor thrombosis. 29 cases were completed by the intraperitoneal route, no transit to open; combined tumor thrombus in 11 cases were preoperative interventional renal artery embolization; operation time (164.4 ± 40.0) min; intraoperative blood loss 50 ~ 1 200ml. The mean gastrointestinal function recovery after operation was 2.65 ± 0.71 d, the average drainage time was 3.17 ± 1.36 days, and the average postoperative hospital stay was 6.8 ± 2.5 days. No intraduodenal, hepatic, colonic and macrovascular injuries occurred in this group. No intra-abdominal infection and postoperative intestinal obstruction were found. There were 9 cases in T2N0 ~ 1M0 ~ 1, 14 cases in T3N0 ~ 1M0 ~ 1 and 6 cases in T4N0 ~ 1M0 ~ 1 after operation. Followed up for 1 to 24 months, 8 cases (27.6%) had renal bed tumor recurrence or distant metastasis. CONCLUSIONS: Based on initial operative experience and follow-up, it is safe and feasible to perform laparoscopic radical nephroureterectomy with abdominal robots. Long-term and prospective controlled studies will facilitate the assessment of this technique.