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目的:总结机器人辅助腹腔镜技术治疗单侧多发肾肿瘤的资料,评价手术安全性和可行性,提高治疗水平。方法:回顾性分析2013年11月~2016年4月采用机器人辅助腹腔镜手术治疗的22例单侧多发肾肿瘤患者的临床资料和预后信息。结果:22例手术均获得成功,其中4例因分级较高而采用根治性切除术。22例患者中,男21例,女1例,平均50.3岁。11例患者肿瘤病灶大于2个,6例患者术前有另一侧肾癌根治手术史。术前肌酐(94.83±19.73)μmol/L,术后3个月肌酐(146.10±54.79)μmol/L,温缺血(30.08±17.50)min,术中出血(222.7±306.5)ml,术后住院(6.9±2.9)d,术后禁食(1.9±0.8)d。17例经腹腔手术入路,5例经后腹腔手术入路;6例行肾动脉低温灌注机器人辅助腹腔镜肾部分切除术。术后病理:21例为透明细胞癌,1例乳头状细胞癌。所有患者均无切缘阳性及淋巴结转移,术后随访8~37个月,均未出现复发及转移。结论:机器人辅助腹腔镜治疗单侧多发肾肿瘤是安全、可行、有效的方法。近期肿瘤控制效果满意,远期疗效有待大样本研究。
OBJECTIVE: To summarize the data of robot assisted laparoscopy in the treatment of unilateral multiple renal tumors, evaluate the safety and feasibility of surgery and improve the treatment level. Methods: The clinical data and prognostic information of 22 patients with unilateral multiple nephromas treated with robotic-assisted laparoscopic surgery from November 2013 to April 2016 were retrospectively analyzed. Results: Twenty-two cases were successful. Among them, 4 cases had radical resection because of higher grade. Twenty-two patients, 21 males and 1 female, average 50.3 years old. Eleven patients had more than two tumor lesions and six had a history of radical surgery of the other kidney before surgery. Preoperative creatinine (94.83 ± 19.73) μmol / L, creatinine (146.10 ± 54.79) μmol / L 3 months after operation, warm ischemia (30.08 ± 17.50) min, intraoperative blood loss (222.7 ± 306.5) ml and postoperative hospital stay (6.9 ± 2.9) d, postoperative fasting (1.9 ± 0.8) d. 17 cases underwent transperitoneal surgery and 5 cases underwent retroperitoneal surgery. Six cases underwent renal artery hypothermia perfusion assisted by laparoscopic partial nephrectomy. Postoperative pathology: 21 cases of clear cell carcinoma, 1 case of papillary carcinoma. All patients had no positive margins and lymph node metastases, and were followed up for 8 to 37 months. No recurrence or metastasis occurred. Conclusion: Robot-assisted laparoscopic treatment of unilateral multiple renal tumors is a safe, feasible and effective method. Recent tumor control is satisfactory, long-term efficacy needs to be a large sample of studies.