机器人辅助腹腔镜肾部分切除术不同手术入路的近期疗效分析

目的:探讨机器人辅助腹腔镜肾部分切除术手术入路的选择及各自优势。方法:收集2014年9月～2018年10月在我院行机器人辅助腹腔镜肾部分切除术的患者资料,回顾性分析并比较3种手术入路对手术时间、肾动脉阻断时间、出血量及并发症等方面的影响。患者345例,男181例,女164例;其中经腹入路102例,经腰入路121例,经腰腹联合入路122例,手术均由单一术者完成。结果:345例均成功完成手术。经腹、经腰和腰腹联合入路的手术时间分别为(93.0±12.7)min、(89.0±16.5)min和(71.0±9.7)min,组间比较差异有统计学意义(P<0.05)。3种入路在肾动脉阻断时间、术中出血量、术后并发症发生率方面组间比较差异均无统计学意义(P>0.05)。术后患者的肠道功能恢复时间,经腰、经腰腹联合入路早于经腹入路组(P<0.05),但经腰与腰腹联合入路差异无统计学意义(P>0.05)。所有患者术后病理学检查标本切缘均为阴性。病理诊断结果肾透明细胞癌312例,乳头状肾细胞癌21例,嫌色细胞癌12例。术后患者随访1～40个月,3组患者在随访期内均无肿瘤复发、远处转移、肿瘤特异性死亡等病例。结论:机器人辅助腹腔镜肾部分切除通过腰腹联合入路在缩短手术和肠道恢复时间具有优势,是一种安全、有效的手术方式。

Analysis of therapeutic effect among different accesses robot-assisted laparoscopic partial nephrectomy

Objective:To investigate the different surgical accesses and advantages of robot-assisted laparoscopic partial nephrectomy.Method:Totally,345 patients performed robot-assisted laparoscopic partial nephrectomy were recruited from September 2014 to October 2018.The operation time,the warm ischemic time,the blood loss,complication,etc were retrospectively analyzed among 3 surgical accesses.The male and female were181 and 164,respectively.The transperitoneal,retroperitoneal,combined transperitoneal and retroperitoneal access was 102,121,122,respectively.All the surgeries were performed by one surgeon.Result:All the procedures were performed successfully.The mean procedure time of transperitoneal,retroperitoneal,combined transperitoneal and retroperitoneal access was(93.0±12.7)min,(89.0±16.5)min and(71.0±9.7)min(P<0.05).There was no significant difference in blood loss,the warm ischemic time or complication among different accesses(P>0.05).For pathology,there were 312 clear cell renal cell carcinoma cases,21 papillary renal cell carcinoma cases and 12 chromophobe cell renal cell carcinoma cases.Surgical margins were all negative.There was no recurrence,metastasis or tumor specific death,etc,during 1 to 40 months of follow-up period.Conclusion:Combined access for robot-assisted laparoscopic partial nephrectomy is a safe and effective surgical access for its superiority in opertion time and bowel recovery.