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目的:通过比较机器人辅助腹腔镜肾部分切除术(robot-assisted laparoscopic partial nephrectomy,RALPN)、腹腔镜肾部分切除术(laparoscopic partial nephrectomy,LPN)和开放性肾部分切除术(open partial nephrectomy,OPN),探讨机器人辅助腹腔镜肾部分切除术在治疗小肾癌方面的优势。方法:2009年1月~2013年5月,我科共完成50例小肾癌的肾部分切除术,其中12例RALPN,15例LPN,23例OPN。将三组患者术前基线情况、手术数据和术后GFR变化进行比较。结果:三组患者术前基线情况差异无统计学意义(P>0.05)。50例手术均顺利完成,除LPN组1例术后出现尿漏,其余无术后并发症。RALPN和OPN在手术时间(operating time,OT)、热缺血时间(warm ischemic time,WIT)、失血量(estimated blood loss,EBL)方面较LPN有优势(P<0.05),RALPN在住院时间(hospital stay,HS)较LPN和OPN占优势(P<0.05)。无论哪种术式,对患侧肾功能均无明显影响(手术前后GFR比较,P>0.05)。结论:RALPN是一种创伤小、疗效确切、安全可靠的术式。同LPN比较,其优势明显。同OPN相比,也有恢复更快的优势。在不考虑手术费用的前提下,RALPN是治疗小肾癌的优先选择。
Objective: To compare the effects of robot-assisted laparoscopic partial nephrectomy (RALPN), laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) , To explore the advantages of robot assisted laparoscopic partial nephrectomy in the treatment of small renal cell carcinoma. Methods: From January 2009 to May 2013, 50 cases of small renal cell carcinoma underwent partial nephrectomy in our department. Among them, 12 cases were RALPN, 15 cases were LPN and 23 cases were OPN. Preoperative baseline conditions, surgical data and postoperative GFR changes were compared between the three groups. Results: There was no significant difference in preoperative baseline between the three groups (P> 0.05). All the 50 cases were successfully performed. One case of LPN had postoperative urinary leakage, and the rest had no postoperative complications. RALPN and OPN were superior to LPN in operating time (OT), warm ischemic time (WIT), and estimated blood loss (EBL) (P <0.05) hospital stay, HS) were more dominant than LPN and OPN (P <0.05). No matter what type of operation, no significant effect on ipsilateral renal function (GFR before and after surgery, P> 0.05). Conclusion: RALPN is a less invasive, effective, safe and reliable operation. Compared with LPN, its obvious advantages. Compared with the OPN, there are faster recovery advantages. Without considering the cost of surgery, RALPN is the preferred treatment for small renal cell carcinoma.