机器人辅助腹腔镜与腹腔镜肾部分切除术治疗巨大肾血管平滑肌脂肪瘤的疗效比较

目的:比较机器人辅助腹腔镜肾部分切除术(RAPN)与腹腔镜肾部分切除术(LPN)对巨大肾血管平滑肌脂肪瘤(RAML)的疗效。方法:回顾性分析浙江省人民医院2014年10月至2020年5月行手术治疗的43例巨大RAML(直径>7cm)患者的临床资料，其中23例行RAPN，20例行LPN。RAPN组男4例，女19例；中位年...

Efficacy comparison of robot-assisted partial nephrectomy and laparoscopic partial nephrectomy in the treatment of giant renal angiomyolipoma

Objective To evaluate the efficacy of robot-assisted partial nephrectomy(RAPN)and laparoscopic partial nephrectomy(LPN)in the treatment of giant(>7cm)renal angiomyolipoma(RAML).Methods The clinical data of 43 patients with giant RAML(>7cm)who underwent surgery in Zhejiang People's Hospital from October 2014 to May 2020 was retrospectively analysed,including 23 routine RAPN and 20 routine LPN.The median age of patients in the RAPN group was 45(17-65)years old,with 4 males and 19 females.The median body mass index(BMI)was 20.3(18.0-25.7)kg/m².Tumors located on the left side in 11 cases and on the right side in 12 cases.Tumors located on upper pole in 9 cases,middle pole in 5 cases,lower pole in 5 cases.The median R.E.N.A.L.score was 8(4-12)points and the largest tumor diameter was 7.5(7.1-17.0)cm.The median age of patients in the LPN group was 53(27-78)years old,with 1 males and 19 females.The median BMI was 21.4(19.0-25.5)kg/m².Tumors located on the left side in 9 cases and right side in 11 cases.Tumors located on the upper pole in 7 cases,middle pole in 4 cases and lower pole in 5 cases.4 cases were multiple tumors,2 cases were bilateral,and 2 cases were unilateral.The median R.E.N.A.L.score was 8(4-12)points and the median maximum diameter of tumor was 7.3(7.0-20.0)cm.There was no statistically significant difference in general information between the two groups(P>0.05).The operation time,warm ischemia time,intraoperative blood loss,postoperative complications,postoperative recovery,renal function and other indicators of the two groups were compared,as well as the follow-up results.Results The operations in both groups were successfully completed,and none of them were transferred to open surgery.Patients in the RAPN group had markedly lower median operation time[115(90-220)vs.145(120-240)min],and reduced median time of warm ischemia[15(10-25)vs.23(20-28)min]than those in the LPN group,the difference between the two groups was statistically significant(P<0.05).There were no significant differences in the median time of eating[1(1-2)vs.1(1-3)d],time of extubation[4(3-16)vs.5(3-14)d],postoperative absolute time in bed[4(3-7)vs.4(2-12)d],hospitalization time[7(5-16)vs.8(4-14)d],creatinine change[11.3(1.6-44.8)vs.18.2(1.0-54.8)μmol/L],eGFR change[21.5(1.8-43.5)vs.22.1(5.6-51.3)ml/(min·1.73m²)],and hemoglobin change[22.5(11-43)vs.23.0(9-62)g/L]between the two groups(P>0.05).The incidence of postoperative complications in the RAPN group and the LPN group were 0 and 15%(3/20),respectively,and the difference was statistically significant(P<0.05).3 patients had blood transfusion during the operation,because 2 patients had renal wound hemorrhage.During the operation,ultrasonic scalpel electrocoagulation to halt bleeding and hemostatic cotton padding were performed,which improved after suture.One case had active hemorrhage from the renal wound arteries after surgery,which improved after blood transfusion and embolization.Another 2 patients had postoperative fever,improved after anti-infection and antipyretic treatment.There was no leakage of urine after operation in RAPN group and LPN group.The RAPN group was followed up for 6 months to 45 months with a median time of 12 months,and the LPN group was 8 months to 50 months with a median time of 15 months.No tumor recurrence or delayed renal stump bleeding was identified.Conclusions Compared with LPN,RAPN therapy of giant RAML can shorten the operation time and warm ischemia time,and decrease postoperative complications,the two have similar short-term follow-up results in terms of tumor control and renal function protection.