作　　者： (周晓晨）; (刘伟鹏）; (张成）; (李煜）; (王共先）; (傅斌）;

机构地区： 南昌大学第一附属医院泌尿外科,南昌330006

出　　处： 《临床泌尿外科杂志》 2017年第8期580-584,共5页

摘　　要： 目的:介绍肾肿瘤的机器人辅助经腹膜后腔入路超薄实质层肾部分切除术手术技术及经验。方法:回顾性分析2015年2月~2017年1月的58例肾肿瘤行机器人辅助经腹膜后腔入路超薄肾实质层肾部分切除术,正常肾实质切除层厚控制在0.2cm左右。男33例,女25例,平均年龄(56.3±4.9)岁,平均体质指数(22.5±4.2)kg/m^2,平均肿瘤最大径(3.2±2.1)cm,肿瘤临床分期均为cT1期,术前患侧eGFR平均(79.3±13.1)ml·min^(-1)·1.73m^(-2)。结果:手术均顺利完成,无中转开放病例,无输血病例,无严重术中、术后并发症发生。术后病理:透明细胞癌47例,错构瘤5例,乳头状瘤3例,囊性肾癌2例,嗜酸性细胞瘤1例;无切缘阳性。平均手术时间(54.5±21.3)min,平均失血量(79.9±40.1)ml,平均热缺血时间(13.2±8.3)min。平均随访9(5~14)个月,均无肿瘤复发表现。术后1周患侧eGFR平均(65.4±8.3)ml·min^(-1)·1.73m^(-2);术后3个月患侧eGFR平均(71.4±12.1)ml·min^(-1)·1.73m^(-2),与术前相比未显著降低(P>0.05)。结论:机器人辅助经腹膜后腔入路超薄实质层肾部分切除术是T_1期肾肿瘤安全、有效的手术技术,在确保肿瘤控制效果的前提下可较好地保留患肾功能。 Objective：To introduce the technique and our experience of ＂Ultra-thin Parenchyma＂resection of the renal tumor in robotic partial nephrectomy via retroperitoneal approach.Method：Fifty-eight consecutive robotic retroperitoneal partial nephrectomies for cT1 renal tumor performed by a single surgeon between February2015 and January 2017 were retrospectively reviewed,including 33 male and 25 female patients aged（56.3±4.9）years old.Average BMI was（22.5±4.2）kg/m^2.Aaverage tumor size was（3.2±2.1）cm.Average eGFR was（79.3±13.1）ml·min^（-1）·1.73m^（-2）.Result：All operations were successfully performed robotically without conversion,transfusion or other significant complications.Postoperative pathology revealed 47 cases of clear cell carcinoma,5cases of angiomyolipoma,3 cases of papilloma,2 cases of cystic renal cancer and 1 case of eosinophilic cytoma originated from the kidney.No positive surgical margin was noted.Average operative time was（54.5±21.3）min.Average estimated blood loss was（79.9±40.1）ml.Average warm ischemic time was（13.2±8.3）min.No regional recurrence was found during a mean follow-up period of nine months.Postoperative eGFR was（65.4±8.3）and（71.4±12.1）ml·min^（-1）·1.73m^（-2） at one-week and three-month follow-up,respectively.No significant decrease of eGFR was noted（P〉0.05）.Conclusion： ＂Ultra-thin Parenchyma＂resection of the renal tumor in robotic partial nephrectomy via retroperitoneal approach is a safe and effective surgical technique for the removal of cT_1 renal tumor,which maximizes the preservation of renal function while ensuring tumor control.

关 键 词： 肾肿瘤 机器人辅助肾部分切除术 经腹膜后腔入路