Comparisons of the safety and effectiveness between robot-assisted and laparoscopic partial nephrectomy for cT2a renal cancer
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摘要: 目的 比较分析机器人辅助肾部分切除术(robot-assisted partial nephrectomy，RAPN)与腹腔镜肾部分切除术(laparoscopic partial nephrectomy，LPN)治疗cT2a期肾癌的手术安全性和可行性，并分析患者预后情况。方法 回顾性分析2019年1月—2021年1月于上海交通大学医学院附属仁济医院泌尿科接受肾部分切除术治疗的33例cT2a期肾癌患者，根据手术方式分为RAPN组和LPN组，采用SPSS软件中的t检验及χ2检验比较基线特征、围手术期资料和术后结局。结果 RAPN组和LPN组临床资料比较，差异无统计学意义(P>0.05)。RAPN组手术时间为(138.15±19.94) min，少于LPN组的(167.15±38.49) min；RAPN组术中出血量为(228.55±78.16) mL，少于LPN组的(324.54±107.50) mL，差异均有统计学意义(P < 0.05)。LPN组手术中热缺血时间为(33.00±4.14) min，明显长于RAPN组的(22.05±4.55) min，差异有统计学意义(P < 0.05)。2组术后严重并发症(Clavien-Dindo分级≥3级)发生率比较差异无统计学意义(P>0.05)。2组患者术前血肌酐(serum creatinine，Scr)值比较差异无统计学意义(P=0.70)，但RAPN组患者术后第1天Scr值明显低于LPN组患者(P=0.001)。术后随访3年，2组患者慢性肾脏病发病率比较差异有统计学意义(P < 0.05)，但复发转移率比较差异均无统计学意义(P>0.05)。结论 RAPN与LPN治疗cT2a期肾癌总体安全有效，在有经验丰富的医师情况下，两者都能达到良好的手术效果。相较于LPN，RAPN有更短的热缺血时间，更能充分有效地保护患者术后肾功能，术后远期肾脏相关疾病发病率更低。Abstract: Objective To compare the safety and effectiveness between robot-assisted nephrectomy and laparoscopic nephrectomy in the treatment of cT2a renal carcinoma, and to analyse the prognosis of these patients.Methods A retrospective analysis was performed on 33 patients with stage cT2a renal cancer who received nephrectomy in the Urology Department of Shanghai Renji Hospital from January 2019 to January 2021. Surgical methods included robot-assisted partial nephrectomy (RAPN) and laparoscopic partial nephrectomy (LPN). Baseline characteristics, perioperative data and postoperative outcomes were compared between two surgical methods by t test and χ2 test in SPSS software.Results There was no significant difference between the robot group (RAPN) and the laparoscopic group (LPN) in general clinical data related factors (P>0.05). The operative time of RAPN group ([138.15±19.94] min) was less than that of LPN group ([167.15±38.49] min), and the intraoperative blood loss of RAPN group ([228.55±78.16] mL) was less than that of LPN group ([324.54±107.50] mL). The differences were statistically significant (P < 0.05). The duration of hot ischemia in LPN group ([33.00±4.14] min) was significantly longer than that in RAPN group ([22.05±4.55] min), and the difference was statistically significant (P < 0.05). There was no statistically significant difference in the incidence of postoperative serious complications (Clavien-Dindo grade ≥3) between the two groups (P>0.05). There was no significant difference in preoperative serum creatinine (Scr) between the two groups (P=0.70), but the Scr in the RAPN group was significantly lower than that in the LPN group on the first day after surgery (P=0.001). There was significant difference in the incidence of chronic kidney disease 3 years after operation between the two groups (P < 0.05). After 3 years of follow-up, there was no significant difference in 3-year recurrence or metastasis rate between RAPN group and LPN group (P>0.05).Conclusion RAPN and LPN in the treatment of stage cT2a renal cancer are generally safe and effective, and both techniques can achieve good surgical results operated by experienced physicians. Compared with laparoscopy alone, robot-assisted nephrectomy has a shorter hot ischemia time, can fully and effectively protect patients' postoperative renal function, and has a lower incidence of long-term postoperative nephro-related diseases.
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Key words:
- partial nephrectomy /
- robot-assisted /
- laparoscopy /
- cT2a renal cancer
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表 1 2组患者临床资料比较
例，X±S 临床参数 RAPN组(20例) LPN组(13例) P值 性别 0.70 男 13 10 女 7 3 年龄/岁 59.75±9.21 60.69±5.51 0.74 BMI/(kg/m2) 24.41±2.97 23.57±3.96 0.49 肿瘤直径/cm 8.48±0.85 8.75±0.68 0.34 肿瘤位置 0.16 左侧 12 4 右侧 8 9 R.E.N.A.L.评分/分 7.70±0.80 8.15±0.55 0.09 
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表 2 2组患者围手术期相关资料比较
例，X±S 指标 RAPN组(20例) LPN组(13例) P值 手术入路 1.000 腹膜后 13 8 经腹 7 5 手术时间/min 138.15± 19.94 167.15± 38.49 0.008 热缺血时间/min 22.05±4.55 33.00±4.14 < 0.001 术中出血量/mL 228.55± 78.16 324.54± 107.50 0.006 Clavien-Dindo分级 1.000 < 3级 19 12 ≥3级 1 1 输血 0.025 否 19 8 是 1 5
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表 3 2组患者术前及术后肾功能比较
例，X±S 指标 RAPN组(20例) LPN组(13例) P值 术前Scr/(μmol/L) 76.35± 13.79 78.69± 20.86 0.700 术后第1天Scr/ (μmol/L) 105.20± 27.42 152.77± 49.21 0.001 术后第3年eGFR/ (mL/min/1.73 m2) 85.83± 16.72 66.45± 17.69 0.006 CKD 3级及以上 0.035 否 18 7 是 2 6
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