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目的探讨腹膜外入路Da Vinci机器人辅助腹腔镜肾部分切除术的可行性及临床价值。方法回顾性分析2014年9月至2015年5月12例行腹膜外入路Da Vinci机器人辅助腹腔镜肾部分切除术患者的临床资料,患者年龄34~72岁,平均57岁;男性8例,女性4例;左侧5例,右侧7例;肿瘤直径2.5~4.0 cm,平均3.0 cm。术前完善胸片排除远处转移,临床分期均为T1aN0M0期。结果 12例患者均顺利完成腹膜外入路Da Vinci机器人辅助腹腔镜肾部分切除术,手术时间65~85 min,平均70 min;术中出血20~80 ml,平均45 ml;动脉阻断时间15~24 min,平均19 min;无中转开放或传统腹腔镜手术,无术中输血,未发生严重手术并发症。术后病理:11例为肾透明细胞癌,1例为肾血管平滑肌脂肪瘤。12例患者术后随访1~8个月,无复发或转移。结论腹膜外入路Da Vinci机器人辅助腹腔镜部分切除术安全、可行,值得推广。
Objective To explore the feasibility and clinical value of extraperitoneal Da Vinci robot assisted laparoscopic partial nephrectomy. Methods The clinical data of 12 patients undergoing laparoscopic partial nephrectomy with Da Vinci robot assisted by extraperitoneal approach were retrospectively analyzed from September 2014 to May 2015. The patients were 34 to 72 years old with an average of 57 years old. There were 8 males, 4 females; 5 on the left and 7 on the right; and the diameter of the tumor was 2.5-4.0 cm (3.0 cm on average). Improve the preoperative chest radiography to exclude distant metastasis, clinical stage were T1aN0M0 period. Results All 12 patients underwent successful laparoscopic nephrectomy with Da Vinci robot assisted by extraperitoneal route. The operative time ranged from 65 to 85 minutes (mean, 70 min). The intraoperative blood loss ranged from 20 to 80 ml with an average of 45 ml. The mean arterial occlusion time ~ 24 min, an average of 19 min; no transit or traditional laparoscopic surgery, no intraoperative blood transfusion, no serious surgical complications. Postoperative pathology: 11 cases of clear cell renal cell carcinoma, 1 case of renal angiomyolipoma. Twelve patients were followed up for 1 to 8 months without recurrence or metastasis. Conclusion The extraperitoneal approach of Da Vinci robot assisted laparoscopic partial resection is safe, feasible and worthy of promotion.