机器人辅助腹腔镜下肾部分切除术两种入路的对比研究

目的:比较经腹膜后和经腹腔两种手术入路机器人辅助腹腔镜下肾部分切除术的临床疗效。方法:回顾性分析2018年6月-2021年1月于甘肃省人民医院行肾部分切除术患者67例的临床资料,根据手术入路不同将患者分为经腹腔组和经腹膜后组。经腹腔入路组患者共26例(男11例,女15例),平均年龄为(53.5±9.7)岁;经腹膜后入路组患者共41例(男20例,女21例),平均年龄为(55.2±12.5)岁。比较两组患者的手术疗效、病理结果和围手术期情况。结果:67例患者的机器人辅助腹腔镜下肾部分切除术均顺利完成,无中转开腹手术。经腹腔入路和经腹膜后入路组术中出血量、热缺血时间、手术时间、术后并发症发生率比较,差异均无统计学意义(P>0.05)。而经腹膜后入路组患者的术后肠道功能较经腹腔入路组恢复快(P<0.05)。结论:采用经腹膜后入路在机器人辅助腹腔镜下肾部分切除术中可以取得和经腹腔入路同样的手术效果,而且其在术后肠道功能恢复方面具有优势。

Comparison of transperitoneal and retroperitoneal approach in robot-assisted laparoscopic partial nephrectomy

Objective: To compare the clinical efficacy of transperitoneal and retroperitoneal approach in robot-assisted laparoscopic partial nephrectomy. Methods: The clinical data of 67 patients underwent partial nephrectomy in Gansu Provincial People’s Hospital from June 2018 to January 2021 were retrospectively analyzed. Patients were divided into transperitoneal group and retroperitoneal group according to different surgical approaches. There were 26 patients in the transperitoneal group, including 11 males and 15 females, with the average age of(53.5±9.7) years. There were 41 patients in the retroperitoneal group, including 20 males and 21 females, with the average age of(55.2±12.5) years. Surgical results, pathological results and perioperative indicators of the two groups of patients were compared and analyzed. Results: 67 cases of robot-assisted laparoscopic partial nephrectomy were all successfully completed without conversion to open surgery. No statistically significant difference on blood loss, warm ischemia time, operative time and postoperative complication rate between the two groups was found(P>0.05). However, the intestinal function of retroperitoneal group recovered faster than the transperitoneal group(P<0.05). Conclusion: The retroperitoneal approach can achieve the same surgical effect as the transperitoneal approach in robot-assisted laparoscopic partial nephrectomy, and it has advantages on postoperative intestinal function recovery over transperitoneal approach.