机器人辅助腹腔镜与后腹腔镜下肾血管平滑肌脂肪瘤剜除术的比较

目的比较机器人辅助腹腔镜（RALE）与后腹腔镜下肾血管平滑肌脂肪瘤剜除术（rLE）的临床应用。方法回顾性分析解放军总医院2005年6月至2009年1月共17例接受肾血管平滑肌脂肪瘤剜除手术治疗的病例资料，其中11例行后腹腔镜下单纯剜除术，6例行机器人辅助腹腔镜“剜除＋肾部分切除术”。结果rLE组与RALE组的平均手术时间分别为84．6±15．1（60～110）rain和158．3±37．1（120～210）min[P=0．0000]，术中出血量50．9±27．7（20～100）ml和388．3±439．6（30～1000）ml[P=0．01971，术中。肾动脉阻断时问为0rain和29±8．7（20—45）min[P=0．0000]，围手术期输血率为0％（0／11）和33．3％（2／6），术后引流管留置均为2—3d，术后住院时间平均8．8（6～14）d和8（7。9）d。术后两组均未出现尿漏及继发出血等并发症。随访21～24个月，所有患者未见局部病灶残留及复发，肾功能均在正常范围。结论rLE及RALE均为安全有效的治疗肾血管平滑肌脂肪瘤的选择性保留。肾单位手术方法。随着操作经验的积累和手术技术的发展，机器人腹腔镜的优势将更加明显。

A comparison of robot-assisted laparoscopic versus pure retroperitoneal laparoscopic enucleation for renal angiomyolipoma

Objective To compare the effect of robot-assisted laparoscopic enucleation （RALE） with that of pure retroperitoneal laparoscopic enucleation （rLE） enucleation for renal angiomyolipoma. Methods This was a retrospective analysis consisting of 17 patients with renal angiomyolipoma from June 2005 to January 2009 in General Hospital of PLA, China . Eleven of them received pure tumor enucleation with rLE, while the rest 6 received pure enucleation and partial nephrectomy with RALE. The time of follow up was 21 - 24 months. Results The mean operation time of rLE and RALE were 84.6 ± 15.1 （ 60 - 110 ） min and 158.3 ＋ 37.1 （ 120 -210 ） min[ P= 0.0000 ] respectively. The blood loss was 50.9 ± 27.7 （ 20 - 100 ） ml and 388.3 ＋ 439.6 （ 30 - 1000 ） ml [ P= 0.0197 ],respectively. The renal artery blockade time during surgery are 0 rain and 29 ± 8.7 （ 20 - 45 ） min [ P = 0.0000 ],respectively. Theperioperative blood transfusion rate are 0% （0/11 ）and 33.3% （2/6）, respectively. The indwelling duration of drainage are both 2-3d,and the mean length of postoperative hospitalization time is 8.8 （6-14）and 8 （7-9）days, respectively. Both rLE and RALE enucleation for renal angiomyolipoma did not cause any complications such as urinary leakage and secondary hemorrhage. All patients exhibit no local residual or recurrence and their renal function are normal during the follow-up. Conclusions Both rLE and RALE tumor enucleation with partial nephreetomy are safe and effective in the treatment of renal angiomyolipoma. With the accumulation of operation experience and the development of surgical technique, the advantage of RALE will become more and more obvious.