微创技术下肾部分切除术治疗完全内生型肾脏肿瘤的手术要点和临床疗效分析

王正; 王杰; 鲍一; 时佳子; 王安邦; 甘欣欣; 吴震杰; 张宗勤; 刘冰; 王林辉

doi:10.13201/j.issn.1001-1420.2021.07.010

微创技术下肾部分切除术治疗完全内生型肾脏肿瘤的手术要点和临床疗效分析

- 海军军医大学第二附属医院上海长征医院泌尿外科(上海, 200003)

详细信息

通讯作者: 王林辉,E-mail:wanglinhuicz@163.com

中图分类号: R737.11

收稿日期: 2020-09-26

Surgical technique and clinical efficacy of partial nephrectomy for completely endophytic renal tumors via minimally invasive technique

- Department of Urology, Second Affiliated Hospital of Naval Medical University, Changzheng Hospital, Shanghai, 200003, China

More Information

Corresponding author: WANG Linhui, E-mail: wanglinhuicz@163.com

Received Date: 26 September 2020

摘要

摘要: 目的:探讨腹腔镜肾部分切除术(laparoscopic partial nephrectomy,LPN)及机器人辅助腹腔镜肾部分切除术(robot-assisted laparoscopic partial nephrectomy,RAPN)治疗完全内生型肾脏肿瘤的可行性、安全性及临床疗效。方法:回顾性分析2010年12月—2019年10月同一研究小组完成的99例完全内生型肾脏肿瘤行LPN和RAPN患者的临床资料。其中男61例,女38例,平均年龄(49.31±11.90)岁,平均BMI(24.12±3.39) kg/m²,麻醉评分(ASA)平均(1.77±0.47)分。肿瘤均为单发,左侧41例,右侧58例,肿瘤最大径(2.79±1.01) cm,平均R.E.N.A.L.评分(9.07±1.31)分。术前患侧肾脏肾小球滤过率(GFR)平均值(52.20±12.36) mL/min,健侧肾脏GFR平均(53.23±12.44) mL/min。分析围手术期数据,探讨手术技巧,评估手术效果。结果:所有手术均顺利完成,无中转开放或中转根治性肾切除病例。其中术式包括行LPN 28例,行RAPN 71例;手术入路经腹腔入路42例,经后腹腔入路57例。平均手术时间(172.01±52.05) min,平均术中出血(134.14±131.28) mL。阻断方式除2例采用分支动脉阻断,其余均采用肾主动脉干阻断,平均阻断时间(23.69±7.77) min。术后病理为良性肿瘤20例,恶性肿瘤79例。术后肿瘤切缘阳性发生率为0,并发症发生率7.1%,7例均为术后出血,其中1例伴血尿,4例采取DSA栓塞治疗,3例采取输血等保守治疗,术后平均住院天数(8.26±4.08) d。术后3个月健侧肾脏GFR平均值为(54.72±11.16) mL/min,患侧肾脏GFR平均值为(35.41±12.15) mL/min,术后3个月患侧肾脏GFR较术前平均变化率下降31.8%。单因素分析结果显示肿瘤大小(P=0.021)、R.E.N.A.L.评分(P=0.036)、缺血时间(P=0.001)与术后患侧肾脏功能预后相关。根据28例LPN组肿瘤大小、R.E.N.A.L.评分匹配28例RAPN病例,对比分析围手术期数据后发现RAPN组在手术时间(143 min vs.175 min,P=0.026)、肾动脉阻断时间(21 min vs.25 min,P=0.032)、术后住院天数(6.9 d vs.9.1 d,P=0.037)均优于LPN组,而两组间患肾术前与术后3个月的GFR变化率差异无统计学意义(P=0.622)。结论:对于完全内生型肾肿瘤,RAPN组与LPN组均安全可行,围手术期疗效确切,但远期效果仍需进一步随访观察。
- 肾部分切除术 /
- 完全内生型 /
- 腹腔镜 /
- 机器人 /
- 肾肿瘤
Abstract: Objective: To evaluate the feasibility, safety and clinical efficacy of partial nephrectomy for completely endophytic renal tumors under minimally invasive technique.Methods: Clinical data of 99 patients with completely endophytic renal tumors undergoing traditional laparoscopic partial nephrectomy(LPN) and robot-assisted laparoscopic partial nephrectomy(RAPN) from December 2010 to October 2019 were retrospectively collected in the same research team of the Department of Urology of Changzheng Hospital. Among these patients, the male/female ratio was 61/38 and the mean age of all patients was(49.31±11.90) years old. The mean body mass index(BMI) was(24.12±3.39) kg/m². The mean ASA score was(1.77±0.47). All tumors were solitary including 41 in the left and 58 in the right. The mean diameter of the tumors was(2.79±1.01) cm, and the mean R. E. N. A. L. score was(9.07±1.31). Before operation, the mean renal glomerular filtration rate(GFR) was(52.20±12.36) mL/min of affected side, and the GFR was(53.23±12.44) mL/min of healthy side.Results: All operations were successfully completed, and there was no case of conversion to open surgery or radical nephrectomy. Among them, the LPN/RAPN ratio was 28/71.Forty-two cases were completed through transperitoneal approach, while 57 cases were completed through retroperitoneal approach. The mean operation time was(172.01±52.05) minutes. The ischemia time was(23.69±7.77) minutes and the estimated blood loss was(134.14±131.28) mL. The mean postoperative hospital stay was(8.26±4.08) days. Postoperative pathology results revealed 20 benign tumors and 79 malignant tumors with no positive surgical margin being observed. The complication rate was 7.1%(7/99), which included postoperative bleeding and hematuria. The follow-up time ranged from 4 to 106 months, and the median follow-up time was 25 months. All patients survived without recurrence until the last follow-up. The mean postoperative GFR change in the affected side at 3 months was 31.8%. Univariate analysis showed that tumor size(P=0.021), R. E. N. A. L. score(P=0.036), and ischemia time(P=0.001) were related to the prognosis of renal function after surgery. Twenty-eight cases from RAPN were matched with those from LPN group according to the tumor size and R. E. N. A. L. score, and the cases in RAPN group had superior operation time(143 min vs. 175 min, P=0.026), ischemia time(21 min vs. 25 min, P=0.032) and postoperative hospital stay(6.9 d vs. 9.1 d, P=0.037). There was no significant difference in the rate of GFR change between the two groups(P=0.622).Conclusion: LPN and RAPN were safe and feasible for completely endophytic renal tumors. The therapeutic effect of both methods has been proved, but the long-term effect still needs further observation.
- partial nephrectomy /
- completely endophytic /
- laparoscopy /
- robot /
- renal tumor

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