2种超声探头在机器人辅助腹腔镜肾部分切除手术中的应用比较

胡林义; 祁小龙; 沃奇军; 张大宏

doi:10.13201/j.issn.1001-1420.2019.02.016

2种超声探头在机器人辅助腹腔镜肾部分切除手术中的应用比较

- 浙江省人民医院杭州医学院附属人民医院泌尿外科(杭州, 310014)

详细信息

通讯作者: 张大宏,E-mail:zhangdahongzhj@163.com

中图分类号: R737.11

收稿日期: 2018-06-07

Comparison of the application between two ultrasound probes in assisting robot-assisted partial nephrectomy

- 1. Department of Urology, Zhejiang Provincial Peoples Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, China

More Information

Corresponding author: ZHANG Dahong, E-mail: zhangdahongzhj@163.com

Received Date: 07 June 2018

摘要

摘要: 目的:探讨在机器人辅助腹腔镜肾部分切除手术中(RAPN)使用机器人专用超声探头或普通腹腔镜超声探头的体会和临床价值。方法:回顾性分析2014年10月~2017年12月于我院行RAPN治疗的25例完全内生性肾肿瘤患者的临床资料。按探头不同,将其分为普通探头组(n=15)和机器人专用探头组(n=10)。比较两组围手术期及术后随访指标。结果:所有手术均成功完成,术中均未转开放,切缘阳性率为0,术后1年复发率为0。机器人专用探头组术中肿瘤定位时间明显短于普通探头组[(6.30±2.16) min vs.(10.60±3.64) min,P=0.008],而两组手术时间[(118.00±14.76) min vs.(120.00±14.64) min]、热缺血时间[(20.60±4.09) min vs.(21.27±3.79) min]、估计出血量[(101.00±45.08) ml vs.(111.33±51.53) ml]、术后住院时间天数[(3.80±1.14) d vs.(3.87±1.25) d]、术后3个月复查患肾GFR下降率[(7.50±2.17)% vs.(9.73±3.22)%]等指标的比较差异均无统计学意义。结论:2种超声探头应用于RAPN均是安全可行的。机器人专用探头相比普通腹腔镜探头,主刀使用更加便捷,自主性和准确性更好。
- 肾肿瘤 /
- 超声 /
- 肾部分切除术 /
- 机器人手术
Abstract: Objective: To compare manipulation and perioperative outcomes between two types of intraoperative ultrasound probe, laparoscopic and robotic-specific, in application of robot-assisted partial nephrectomy (RAPN).Method: We retrospectively analyzed 25 cases of endophytic renal cancer treated with RAPN, and these cases were divided into laparoscopic probe group and robotic-specific group.Perioperative outcomes and postoperative follow-up data between these two groups were compared.Result: Laparoscopic probe group had 15 cases and robotic-specific probe group 10 cases.All RAPN cases were successfully completed, and no case underwent open surgery, with 0 positive tumor margin rate and 0 tumor recurrence rate.Robotic specific probe group had significantly shorter tumor location time[(6.30±2.16) min vs. (10.60±3.64) min, P=0.008]than laparoscopic probe group, while no significant difference was found in other indicators such as mean operation time[(118.00±14.76) min vs. (120.00±14.64) min], mean warm ischemia time[(20.60±4.09) min vs. (21.27±3.79) min], estimated blood loss[(101.00±45.08) ml vs. (111.33±51.53) ml], postoperative admission day [(3.80±1.14) d vs. (3.87±1.25) d], postoperative 3-month GFR reduction [(7.50±2.17) % vs. (9.73±3.22) %].Conclusion: Both probes were safe and applicable in RAPN.Robotic-specific probe had advantages of convenience, autonomy and accuracy over laparoscopic probe.
- kidney neoplasms /
- ultrasonography /
- partial nephrectomy /
- robotic surgical procedures

HTML全文

参考文献(18)

[1]	Ljungberg B, Bensalah K, Canfield S, et al.EAU guidelines on renal cell carcinoma:2014update[J].Eur Urol, 2015, 67 (5): 913-924.
[2]	Beauval J B, Peyronnet B, Benoit T, et al.Long-term oncological outcomes after robotic partial nephrectomy for renal cell carcinoma:aprospective multicentre study[J].World J Urol, 2018, 36 (6): 897-904.
[3]	章小平, 蒋国松.复杂性肾肿瘤治疗方法选择及保留肾单位手术的应用[J].临床泌尿外科杂志, 2019, 34 (1): 1-5.
[4]	Hughes-Hallett A, Pratt P, Mayer E, et al.Intraoperative ultrasound overlay in robot-assisted partial nephrectomy:first clinical experience[J].Eur Urol, 2014, 65 (3): 671-672.
[5]	Gettman M T, BluteM L, Chow G K, et al.Robotic-assisted laparoscopic partial nephrectomy:technique and initial clinical experience with DaVinci robotic system[J].Urology, 2004, 64 (5): 914-918.
[6]	汪良, 曾甫清.机器人辅助肾部分切除术的现状与发展[J].临床泌尿外科杂志, 2016, 31 (7): 669-674.
[7]	Sutherland S E, Resnick M I, Maclennan G T, et al.Does the size of the surgical margin in partial nephrectomy for renal cell cancer really matter?[J].J Urol, 2002, 167 (1): 61-64.
[8]	Di Pierro G B, Tartaglia N, Aresu L, et al.Laparoscopic partial nephrectomy for endophytic hilar tumors:feasibility and outcomes[J].Eur J Surg Oncol, 2014, 40 (6): 769-774.
[9]	Komninos C, Shin T Y, Tuliao P, et al.Robotic partial nephrectomy for completely endophytic renal tumors:complications and functional and oncologic outcomes during a 4-year median period of follow-up[J].Urology, 2014, 84 (6): 1367-1373.
[10]	Kim D K, Komninos C, Kim L, et al.Robot-assisted Partial Nephrectomy for Endophytic Tumors[J].Curr Urol Rep, 2015, 16 (11): 76-76.
[11]	武鹏, 孟平, 张龙龙, 等.机器人辅助腹腔镜肾部分切除术治疗肾门部肿瘤的技术优化 (附48例报告) [J].临床泌尿外科杂志, 2017, 32 (10): 789-792.
[12]	Phillips C K, Taneja S S, Stifelman M D.Robot-assisted laparoscopic partial nephrectomy:the NYU technique[J].J Endourol, 2005, 19 (4): 441-445.
[13]	Alenezi A, Motiwala A, Eves S, et al.Robotic assisted laparoscopic partial nephrectomy using contrast-enhanced ultrasound scan to map renal blood flow[J].Int J Med Robot, 2017.
[14]	Kaul S, Laungani R, Sarle R, et al.da Vinci-assisted robotic partial nephrectomy:technique and results at a mean of 15months of follow-up[J].Eur Urol, 2007, 51 (1): 186-191.
[15]	Kaczmarek B F, Sukumar S, Kumar R K, et al.Comparison of robotic and laparoscopic ultrasound probes for robotic partial nephrectomy[J].J Endourol, 2013, 27 (9): 1137-1140.
[16]	Kaczmarek B F, Sukumar S, Petros F, et al.Robotic ultrasound probe for tumor identification in robotic partial nephrectomy:Initial series and outcomes[J].Int JUrol, 2013, 20 (2): 172-176.
[17]	祁小龙, 张琦, 范小明, 等, 腔镜超声辅助腹腔镜肾部分切除术治疗中央型肾肿瘤[J].中国内镜杂志, 2013, 19 (10): 1049-1052.
[18]	Yakoubi R, Autorino R, Laydner H, et al.Initial laboratory experience with a novel ultrasound probe for standard and single-port robotic kidney surgery:increasing console surgeon autonomy and minimizing instrument clashing[J].Int J Med Robot, 2012, 8 (2): 201-205.