机器人辅助腹腔镜与腹腔镜肾部分切除术治疗复杂性肾肿瘤的疗效研究

Comparison of curative effects between robot-assisted laparoscopic partial nephrectomy and laparoscopic partial nephrectomy in treatment of complex renal tumors

摘要:

目的 比较机器人辅助腹腔镜肾部分切除术（robot-assisted laparoscopic partial nephrectomy，RAPN）与腹腔镜肾部分切除术（laparoscopic partial nephrectomy，LPN）治疗复杂性肾肿瘤（R.E.N.A.L评分≥7分）患者的临床疗效。方法 收集2015年1月至2022年9月在重庆医科大学附属第一医院泌尿外科施行的RAPN及LPN治疗复杂性肾肿瘤的患者临床资料，依据手术方式不同分为RAPN组（n=91）与LPN组（n=92）。比较2组患者的临床病理特征及围术期结果。结果 183例肾肿瘤手术均成功完成，RAPN组与LPN组手术时间、术后血清肌酐变化百分比、输血率及切缘阳性率等比较，差异无统计学意义（P>0.05）。RAPN组在住院总时间［（11.3±4.3） d vs. （14.3±4.2） d］、术后住院时间［（5.0±2.6） d vs. （7.4±2.9） d］、术中出血量［（193.0±103.2） mL vs. （231.6±105.0） mL］及热缺血时间［（23.9±6.0） min vs. （28.1±6.6） min］均低于LPN组（P<0.05）。结论 机器人辅助手术系统拥有三维高清视野及灵活的机械臂，操作更为精细、准确，RAPN用于治疗复杂性肾肿瘤可减少术中出血量、缩短热缺血时间、缩短患者住院时间。

Abstract:

Objective To compare the clinical effects of robot-assisted laparoscopic partial nephrectomy（RAPN） and laparoscopic partial nephrectomy（LPN） in patients with complex renal tumors（R.E.N.A.L score ≥7）.Methods The clinical data of patients with complex renal tumors treated by RAPN and LPN in the Department of Urology of The First Affiliated Hospital of Chongqing Medical University from January 2015 to September 2022 were collected and divided into RAPN group（n=91） and LPN group（n=92） according to different surgical methods. The clinicopathological features and perioperative results in the two groups were compared.Results All surgeries were successfully completed. There were no significant differences in operation time，percentage change in postoperative serum creatinine，blood transfusion rate，and resection margin positive rate between the RAPN group and the LPN group（P>0.05）. The total length of hospital stay[（11.3±4.3） d vs. （14.3±4.2） d]，postoperative length of hospital stay[（5.0±2.6） d vs. （7.4±2.9） d]，intraoperative blood loss[（193.0±103.2） mL vs. （231.6±105.0） mL]，and warm ischemia time[（23.9±6.0） min vs. （28.1±6.6） min] were significantly lower in the RAPN group than in the LPN group（P<0.05）.Conclusion The robot-assisted surgery system provides a three-dimensional high-definition field of vision and has a flexible robotic arm，which makes the operation more precise and accurate. RAPN can shorten warm ischemia time，reduce intraoperative blood loss，and shorten length of hospital stay in the treatment of complex renal tumors.