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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:80~184min,平均(122.46±22.55)min;出血量:20~400 ml,平均65ml,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2~7cm,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 investigate the clinical effect and application of precise radical nephrectomy by intraperitoneal route robot. Methods: The clinical data of 24 cases of radical laparoscopic radical nephrectomy performed by a single surgeon from February 2016 to November 2016 were retrospectively analyzed. There were 20 males and 4 females, aged from 22 to 73 The average age is 55. Surgery using 4 arm left 5 holes (right 6 holes) method, that is, a lens hole, 3 holes, left 1 (right 2) auxiliary hole, after 9 steps of fine operation to complete the operation. All patients were preoperative, intraoperative and postoperative data for statistical analysis and summary of surgical experience. Results: All operations were successfully completed, no transit laparotomy. The mean operative time was (122.46 ± 22.55) min. The amount of bleeding was 20-400 ml with an average of 65 ml. No blood transfusion was recorded during the operation. The average duration of postoperative hospital stay was 7.08 ± 1.56 days. The tumors were located in the left kidney in 7 cases , 17 cases of right kidney; the largest diameter of tumor 2 ~ 7cm, average (4.40 ± 1.20) cm. Postoperative pathology: 21 cases of clear cell carcinoma, 1 case of eosinophilic adenoma, 1 case of papillary renal cell carcinoma and 1 case of renal cell carcinoma of Xp11.2 translocation / TF3 fusion gene. Conclusion: The application of scientifically refined surgical procedures to robotic radical nephrectomy has the advantages of short operative time, less intraoperative bleeding, less postoperative complications and higher safety, which can shorten the learning curve and facilitate the operation Urologists provide a valid surgical procedure reference.