国产机器人辅助腹腔镜肾上腺肿瘤切除术五例初步结果

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目的:探讨采用国产内窥镜手术机器人系统行肾上腺肿瘤切除术的安全性、有效性。方法:总结2020年11月至2021年4月北京协和医院采用国产康多内窥镜手术机器人系统治疗的肾上腺腺瘤患者的临床资料。纳入标准:年龄18~75岁;符合肾上腺腺瘤切除手术指征;肿瘤直径≤6 cm;同意签署知情同意书并能定期复诊随访者。排除标准:有同侧上腹部手术史者;有未控制的严重疾病或急性感染者;有心脑血管疾病、血液系统疾病或免疫系统疾病未控制,不能达到手术标准者;妊娠或哺乳期妇女。入组患者均行机器人辅助肾上腺肿瘤切除术。总结患者的一般资料及围手术期数据。结果:本研究共纳入5例患者,男1例,女4例;平均年龄49(34~61)岁。左侧2例,右侧3例;肿瘤直径平均2.2(1.1~3.7)cm。所有患者CT检查均提示腺瘤可能。2例诊断为原发性醛固酮增多症,1例诊断为库欣综合征,2例诊断为无功能腺瘤。5例手术均顺利完成,其中4例经后腹腔入路,1例经腹腔入路。设备对接时间平均3.8(3~6)min,操作时间平均56.2(21~92)min,出血量平均34(20~50)ml。术后病理均为肾上腺皮质腺瘤。患者术后住院时间平均3.6(3~5)d。5例均无术后并发症发生。2例原发性醛固酮增多症患者术前有高血压、低血钾,需口服降压药物控制,术后无需服药,血压、血钾均维持在正常水平。5例术后随访平均1.5(0.5~5.0)个月,所有患者均恢复良好。结论:应用国产内窥镜手术机器人系统行肾上腺肿瘤切除术,出血量少,并发症少,手术安全、有效,但结论尚需大样本多中心研究进一步验证。“,”Objective:To investigate the safety and efficacy of domestic Kangduo robotic surgery system in adrenalectomy.Methods:This study summarized the clinical data of patients with adrenal adenoma who were operated by domestic kangduo robot from November 2020 to April 2021. This study was approved by the hospital ethics committee, and the clinical trials of medical devices were filed. Inclusion criteria: age 18-75 years old; all of them in accordance with the indication of adrenalectomy; tumor volume≤6 cm; agree to sign the informed consent, follow the doctor's advice and follow up regularly. Exclusion criteria: patients with ipsilateral upper abdominal surgery history; patients with severe uncontrolled disease or acute infection; patients with cardiovascular and cerebrovascular diseases, blood system diseases and immune system diseases that are not controlled and can not reach the operation standard; pregnant or lactating women. All patients underwent robot assisted adrenalectomy. The general information and perioperative data of the patients were summarized.Results:Five patients were included in this study, including 1 male and 4 female. The average age was 49 (34-61)years old. There were 2 cases on the left and 3 cases on the right. The average diameter of tumor was 2.2 (1.1-3.7) cm. All patients showed adenoma by CT examination. Two cases were diagnosed as primary aldosteronism, one as Cushing's syndrome, and two as nonfunctional adenoma. All the operations were successfully completed in 5 cases, including 4 cases via retroperitoneal approach and 1 case via peritoneal approach. The average docking time was 3.8 (3-6) min, the average operation time was 56.2 (21-92) min, and the average blood loss was 34 (20-50) ml. The postoperative pathology was adrenal cortical adenoma. The average postoperative hospital stay was 3.6 (3-5) days. No postoperative complications occurred in 5 cases. Two patients with primary aldosteronism had hypertension and hypokalemia before operation, and they needed oral antihypertensive drugs to control them. They did not need medication after operation, and their blood pressure and potassium were maintained at normal levels. All patients were followed up for average 1.5(0.5-5.0)months.Conclusions:Domestic robot assisted laparoscopic adrenalectomy has the advantages of few blood loss, short operation time, few complications. It’s a safe and effective operation, but the conclusion needs to be further verified by large sample and multi-center study.
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