经腹与腹膜后入路机器人辅助腹腔镜肾部分切除术治疗早期肾癌的比较

目的 分析比较经腹与腹膜后两种入路在机器人（达芬奇机器人手术系统）辅助腹腔镜肾部分切除术治疗早期肾癌的效果，并探讨两种入路方式的临床应用价值。方法 2011年12月至2015年2月共收治82例行机器人辅助腹腔镜肾部分切除术的肾癌患者，其中49例采取经腹入路，33例行腹膜后入路。比较两种入路的手术时间、肾动脉阻断时间、术中出血量、术后肠道功能恢复时间、切缘阳性率以及术后并发症的发生率。结果 两组均成功完成手术。两组在手术时间、肾动脉阻断时间、术中出血量、切缘阳性率及术后并发症发生率方面的差异均无统计学意义（P＞0.05）；经腹与腹膜后入路术后的肠道功能恢复时间分别为（5.7±1.4）d和（2.1±0.7）d，差异有统计学意义（P＜0.05）。结论 腹膜后入路机器人辅助腹腔镜肾部分切除术是一种安全、有效的微创术式，可以取得与经腹入路同样的手术效果，并且在术后肠道功能恢复方面具有优势。

Comparison of the transperitoneal and retroperitoneal approach in robotic-assisted laparoscopic partial nephrectomy in treatment of renal carcinoma

Objective To compare the transperitoneal and retroperitoneal approach in robotic assisted （daVinci surgical system） laparoscopic partial nephrectomy（RALPN） in treating the renal carcinoma and assess its clinical efficacy. Methods Clinical data of 82 renal carcinoma patients from December 2011 to February 2015 was retrospectively reviewed. Forty-nine patients were performed RALPN by transperitoneal approach， and 33 patients by retroperitoneal approach. The operation time， renal artery clamping time， operative blood loss， postoperative intestinal discharge time， surgical margin status and postoperative complications were observed and compared. Results Both groups were performed successfully. The operation time， renal artery clamping time， operative blood loss， surgical margin status and postoperative complications did not show any significant difference between the two approaches （P＞0.05）. In retroperitoneal approach group， the postoperative intestinal discharge time was （2.1±0.7）d， shorter than （5.7±1.4）d of transperitoneal approach group （P＜0.05）. Conclusion Retroperitoneal approach appears to be a safe， technically feasible and minimally invasive option in RALPN in treatment of renal carcinoma, which shows equivalent outcomes to those of the transperitoneal approach and advantages in recovery of intestinal function.