[1]张立进,赵晓智,张士伟,等.机器人辅助腹腔镜下单纯肾肿瘤剜除术[J].中华腔镜泌尿外科杂志(电子版),2016,10(03):176-180.[doi:10.3877/cma.j.issn.1674-3253.2016.03.010 ]
　Zhang Lijin,Zhao Xiaozhi,Zhang Shiwei,et al.A clinical observation of endoscopic robotic-assisted simple enucleation for renal tumors[J].,2016,10(03):176-180.[doi:10.3877/cma.j.issn.1674-3253.2016.03.010 ]
点击复制

机器人辅助腹腔镜下单纯肾肿瘤剜除术()
分享到：

中华腔镜泌尿外科杂志(电子版)[ISSN:1006-6977/CN:61-1281/TN]

卷:
10
期数:
2016年03期
页码:
176-180
栏目:
临床研究
出版日期:
2016-06-29

文章信息/Info

Title:
A clinical observation of endoscopic robotic-assisted simple enucleation for renal tumors
作者:
张立进; 赵晓智; 张士伟; 刘光香; 纪长威; 姚林方; 李笑弓; 郭宏骞
210008南京，南京大学医学院附属鼓楼医院泌尿外科
Author(s):
Zhang Lijin;  Zhao Xiaozhi;  Zhang Shiwei;  Liu Guangxiang;  Ji Changwei;  Yao Linfang;  Li Xiaogong;  Guo Hongqian.
Department of Urology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
关键词:
机器人; 肾肿瘤; 剜除术; 临床疗效
DOI:
10.3877/cma.j.issn.1674-3253.2016.03.010
摘要:
目的总结机器人辅助腹腔镜下单纯肾肿瘤剜除术的手术经验，并初步探讨此术式的临床疗效。方法回顾性分析 2014年 11月至 2015年 6月于南京大学医学院附属鼓楼医院接受机器人辅助腹腔镜下肾肿瘤剜除术的 66例患者，其中男 43例、女 23例，平均年龄（ 55±11）岁。本组共 66个肿瘤，其中左肾 41例、右肾 25例。根据 R.E.N.A.L评分：低度复杂（ 4～6分） 3例、中度复杂（ 7～9分） 42例、高度复杂（ 10～12分） 21例。所有肿瘤患者均经术前 CT及超声证实，排除集合系统侵犯或者远处转移，肿瘤平均直径（ 4.6±1.2）cm，临床分期为 T1aN0M0-T2aN0M0。术前平均血红蛋白（ Hb）为（ 131±18）g/L、平均血清肌酐（ SCr）为（ 93±37） μmol/L、患肾平均肾小球滤过率（ GFR）为（ 39± 8）ml/min。结果 66例患者均手术成功，无中转开放。手术平均时间（ 160±35）min，本组 57例患者实施肾动脉阻断，平均热缺血时间（ 19±5）min，平均出血量（ 149±36）ml，术中未输血。术后 1周无继发出血、漏尿等并发症发生。术后 3d复查 Hb（124±12）g/L、SCr（97±32）μmol/L、患肾 GFR（37± 9）ml/min，与术前比较差异均无统计学意义（ P>0.05）。术后病理示：肿瘤切缘阳性率 1.5%，肾良性病变 8例，肾癌 58例。术后平均随访（ 6.7±1.2）个月，未见肿瘤复发及新发慢性肾功能不全等并发症。结论机器人辅助肾肿瘤剜除术是安全的，短期随访研究证实肿瘤控制效果满意，且对肾功能影响较小。

参考文献/References:

[1] Jemal A, Bray F, Center MM, et al, Forman D. Global cancer statistics[J]. CA Cancer J Clin, 2011, 61(2): 69-90.
[2] Gettman MT, Blute ML, Chow GK, et al. Robotic-assisted laparoscopic partial nephrectomy: technique and initial clinical experience with DaVinci robotic system[J]. Urology, 2004, 64(5): 914-918.
[3] Laryngakis NA, Van Arsdalen KN, Guzzo TJ, et al. Tumor enucleation: a safe treatment alternative for renal cell carcinoma [J]. Expert Rev Anticancer Ther, 2011, 11(6): 893-899.
[4] Miyake H, Furukawa JA. Significant impact of R.E.N.A.L. nephrometry score on changes in postoperative renal function early after robot-assisted partial nephrectomy[J]. Int J Clin Oncol, 2015, 20(3): 586-592.
[5] Herr HW. A history of partial nephrectomy for renal tumors [J]. J Urol, 2005, 173(3): 705-708.
[6] Jeong SJ, Kim KT, Chung MS, et al. The prognostic value of the width of the surgical margin in the enucleoresection of small renal cell carcinoma: an intermediate-term follow-up[J]. Urology, 2010, 76(3): 587-592.
[7] Longo N, Minervini A, Antonelli A, et al. Simple enucleation versus standard partial nephrectomy for clinical T1 renal masses: perioperative outcomes based on a matched-pair comparison of 396 patients (RECORd project)[J]. Eur J Surg Oncol, 2014, 40(6): 762-768.
[8] Minervini A, Siena G, Antonelli A, et al. Open versus laparoscopic partial nephrectomy for clinical T1a renal masses: a matched-pair comparison of 280 patients with TRIFECTA outcomes (RECORd Project)[J]. World J Urol, 2014, 32(1): 257-263.
[9] Benway BM, Bhayani SB, Rogers CG, et al. Robotic partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: a multi-institutional comparison of over 200 procedures [J]. J Urol, 2013, 182(3): 866-873.
[10] 刘宇军, 孙立安, 张立, 等. 机器人辅助与腹腔镜下肾部分切除术的近期疗效比较[J]. 中华泌尿外科杂志, 2014, 35 (10):721-725.
[11] Minervini A, Tuccio A, Masieri L, et al. Endoscopic robot-assisted simple enucleation (ERASE) for clinical T1 renal masses:description of the technique and early postoperative results [J]. Surg Endosc, 2015, 29(5): 1241-1249.
[12] Serni S, Vittori G, Masieri L, et al. Robotic vs open simple enucleation for the treatment of T1a-T1b renal cell carcinoma: a single center matched-pair comparison [J]. Urology, 2014, 83(2):331-337.
[13] 徐阿祥, 高江平, 朱捷, 等. 机器人辅助腹腔镜剜除加肾部分切除治疗肾错构瘤6 例报告[J]. 临床泌尿外科杂志, 2011, 26(12):884-887.
[14] 叶长晓, 赵晓智, 邓永明, 等. 腹腔镜肾肿瘤剜除术治疗T1b 期肾癌32 例报告[J]. 现代泌尿外科杂志, 2014, 19(9): 594-598.
[15] Serni S, Vittori G, Frizzi J, et al. Simple enucleation for the treatment of highly complex renal tumors: Perioperative, functional and oncological results [J]. Eur J Surg Oncol, 2015, 41(7): 934-940.

相似文献/References:

[1]李辽源,高新,杨明,等.老年肾脏恶性肿瘤后腹腔镜与开放手术的对比研究[J].中华腔镜泌尿外科杂志(电子版),2008,(03):11.
　LI Liao-yuan,GAO Xin,YANG Ming,et al.A comparative study of laparoscopic and open radical nephrectomy in thc elder[J].,2008,(03):11.
[2]郑军华,彭波,许云飞,等.腹腔镜保留肾单位手术治疗早期肾癌的临床研究(附32例报告)[J].中华腔镜泌尿外科杂志(电子版),2008,(04):15.
　ZHENG jun-hua,PENG Bo,XU Yun-fei,et al.Clinical study of laparoscopic nephron-sparing surgery for early malignant renal tumor(Report of 32 cases)[J].,2008,(03):15.
[3]梁平,吴刚,叶锦,等.后腹腔镜保留肾单位肾脏肿瘤切除术(附15例报告)[J].中华腔镜泌尿外科杂志(电子版),2008,(04):25.
　LIANG Ping,WU Gang,YE Jin,et al.Retroperitoneal laparoscopic nephron-sparing surgery for renal tumor : report of 15 cases[J].,2008,(03):25.
[4]彭波,郑军华,徐丹枫.后腹腔镜肾肿瘤根治切除术围手术期细胞免疫的变化[J].中华腔镜泌尿外科杂志(电子版),2009,(02):49.
　PENG Bo,ZHENG Jun-hua,XU Dan-feng.Effect of retroperitoneal laparoscopic radical nephrectomy of renal carcinoma on perioperative cell immunity[J].,2009,(03):49.
[5]肖克峰,刘大乐,陈彤,等.ZEUS机器人腹腔镜与常规腹腔镜肾上腺肿瘤切除术的比较[J].中华腔镜泌尿外科杂志(电子版),2009,(04):339.
　XIAO Ke-feng,YANG Jiang-gen,CHEN Tong,et al.A comparison of ZEUS robotic-assisted laparoscopic and conventional laparoscopic adrenalectomy[J].,2009,(03):339.
[6]唐录英,陈健宁,刘勇,等.肾原发性淋巴瘤二例报告并文献复习[J].中华腔镜泌尿外科杂志(电子版),2009,(05):427.
[7]罗博,赵小洲,师彦平,等.后腹腔镜肾部分切除术在治疗肾肿瘤的临床应用[J].中华腔镜泌尿外科杂志(电子版),2010,(05):366.
　LUO Bo,ZHAO Xiao-zhou,SHI Yan-ping,et al.Extraperitoneal laparoscopic partial nephrectomy for renal tumor[J].,2010,(03):366.
[8]沈周俊,何威,王浩飞,等.机器人辅助腹腔镜手术治疗高龄高危前列腺癌的可行性初步探讨[J].中华腔镜泌尿外科杂志(电子版),2011,(01):62.
　SHEN Zhou-jun,HE Wei,WANG Hao-fei,et al.Feasibility of robot-assisted laparoscopic surgery for elderly high-risk prostate cancer[J].,2011,(03):62.
[9]陈光彪,王德娟,纳宁,等.肾嗜酸性细胞腺瘤临床诊治及文献复习:附5例报告[J].中华腔镜泌尿外科杂志(电子版),2011,(05):412.
　CHEN Guang-biao,WANG De-juan,NA Ning,et al.The diagnosis and treatment of renal oncocytoma and review of literatures:Report of 5 cases[J].,2011,(03):412.
[10]姚子明,芦志华,胡敬海,等.后腹腔镜肾部分切除术治疗肾脏小肿瘤的疗效及安全性评价[J].中华腔镜泌尿外科杂志(电子版),2012,(01):9.
　YAO Zi-ming,LU Zhi-hua,HU Jing-hai,et al.Retroperiton eoscopic partial nephrectomy for small renal tumors[J].,2012,(03):9.
[11]李智斌,张更,阮东丽,等.单中心机器人辅助腹腔镜与腹腔镜肾部分切除术的比较[J].中华腔镜泌尿外科杂志(电子版),2017,11(02):81.[doi:10.3877/cma.j.issn.1674-3253.2017.02.003 ]
　Li Zhibin,Zhang Geng,Ruan Dongli,et al.Comparative study of single center between robotic assisted laparoscopic partial nephrectomy and laparoscopic partial nephrectomy[J].,2017,11(03):81.[doi:10.3877/cma.j.issn.1674-3253.2017.02.003 ]

备注/Memo

备注/Memo:
通讯作者：郭宏骞，Email：dr.ghq@163.com
更新日期/Last Update: 2016-06-30