CAJ | 학술논문

目的比较机器人辅助腹腔镜下肾部分切除术(RAPN)和经腹途径腹腔镜下肾部分切除术(LPN)治疗肾肿瘤的近期疗效. 方法回顾性分析2009年7月至2013年3月收治的114例肾肿瘤患者的临床资料,其中RAPN组45例、LPN组69例,两组患者的年龄、性别、肿瘤侧别、大小、解剖位置、R.E.N.A.L评分、肾门肿瘤比例、术前估计肾小球滤过率(eGFR)水平比较差异均无统计学意义(P＞0.05).比较两组的手术时间、热缺血时间、术中估计失血量、术后伤口引流量、住院时间、并发症发生率及手术前后eGFR变化的差异. 结果 RAPN组和LPN组的中位手术时间分别为165 min和196 min,热缺血时间分别为21 min和25 min,差异均有统计学意义(P＜0.05),但术后eGFR值及手术前后变化情况差异无统计学意义(P＞0.05).RAPN组和LPN组的术中输血率分别为4.4％(2/45)和5.8％ (4/69),术中中位失血量分别为148 ml与235 ml,术后总引流量分别为167 ml和163 ml,差异均无统计学意义(P＞0.05).RAPN组和LPN组的住院时间分别为6.5d和8.0 d,差异有统计学意义(P＜0.05). RAPN组病理诊断为透明细胞癌27例、乳头状细胞癌5例、嫌色细胞癌2例、血管平滑肌脂肪瘤11例,LPN组为透明细胞癌45例、乳头状细胞癌9例、嫌色细胞癌3例、血管平滑肌脂肪瘤12例,两组比较差异无统计学意义(P＞0.05).RAPN组和LPN组切缘阳性率分别为0％(0/45)和1.4％(1/69),需外科治疗的ClavienⅢ级并发症发生率分别为2.2％(1/45)和2.9％ (2/69),组间比较差异均无统计学意义(P＞0.05).RAPN组随访4～36个月,中1位时间12个月,LPN组随访5～34个月,中位时间13个月,均未见局部复发和远处转移结论与经腹途径LPN相比,RAPN手术时间和热缺血时间较短.短期随访结果显示,在肿瘤预后、肾功能保存以及手术安全性等方面,RAPN和经腹途径LPN的效果相似.
목적 비교궤기인보조복강경하신부분절제술(RAPN)화경복도경복강경하신부분절제술(LPN)치료신종류적근기료효. 방법 회고성분석2009년7월지2013년3월수치적114례신종류환자적림상자료,기중RAPN조45례、LPN조69례,량조환자적년령、성별、종류측별、대소、해부위치、R.E.N.A.L평분、신문종류비례、술전고계신소구려과솔(eGFR)수평비교차이균무통계학의의(P＞0.05).비교량조적수술시간、열결혈시간、술중고계실혈량、술후상구인류량、주원시간、병발증발생솔급수술전후eGFR변화적차이. 결과 RAPN조화LPN조적중위수술시간분별위165 min화196 min,열결혈시간분별위21 min화25 min,차이균유통계학의의(P＜0.05),단술후eGFR치급수술전후변화정황차이무통계학의의(P＞0.05).RAPN조화LPN조적술중수혈솔분별위4.4％(2/45)화5.8％ (4/69),술중중위실혈량분별위148 ml여235 ml,술후총인류량분별위167 ml화163 ml,차이균무통계학의의(P＞0.05).RAPN조화LPN조적주원시간분별위6.5d화8.0 d,차이유통계학의의(P＜0.05). RAPN조병리진단위투명세포암27례、유두상세포암5례、혐색세포암2례、혈관평활기지방류11례,LPN조위투명세포암45례、유두상세포암9례、혐색세포암3례、혈관평활기지방류12례,량조비교차이무통계학의의(P＞0.05).RAPN조화LPN조절연양성솔분별위0％(0/45)화1.4％(1/69),수외과치료적ClavienⅢ급병발증발생솔분별위2.2％(1/45)화2.9％ (2/69),조간비교차이균무통계학의의(P＞0.05).RAPN조수방4～36개월,중1위시간12개월,LPN조수방5～34개월,중위시간13개월,균미견국부복발화원처전이 결론 여경복도경LPN상비,RAPN수술시간화열결혈시간교단.단기수방결과현시,재종류예후、신공능보존이급수술안전성등방면,RAPN화경복도경LPN적효과상사.
Objective To compare the perioperative outcomes of robot-assisted partial nephrectomy (RAPN) with transperitoneal laparoscopic partial nephrectomy (LPN).Methods From July 2009 to March 2013,114 patients were treated in our hospital due to renal carcinoma,including RAPN in 45 patients and LPN in 69 patients.Their data were retrospectively reviewed.Clinical and pathological variables,R.E.N.A.L nephrometry score,operation time (OT),warm ischemia time (WIT),estimated blood loss (EBL),drainage volume,the length of hospitalization,estimated glomerular filtration rate (eGFR) outcomes,and complications were analyzed.Results There were no significant differences between the RAPN and LPN group with respect to patient age,sex,tumor laterality,size,R.E.N.A.L nephrometry score,the rate of hilar tumor and preoperative eGFR (P＞0.05).The median OT was shorter in the RAPN group than that in LPN group (165 min vs.196 min,P＜0.05).The median WIT was shorter in the RAPN than that in LPN group (21 min vs.25 min,P＜0.05).However,there were no significant differences in the postoperative eGFR and changing of eGFR within the 2 groups (P＞0.05).The rate of transfusion was similar between the RAPN (2/45) and LPN (4/69) group (P=0.72).There was also no significant difference in EBL (P=0.16).The drainage volume was also similar within two groups (167 ml vs.163 ml,P=0.81).The length of hospitalization was more favorable in the RAPN group (6.5 d vs.8.0 d,P=0.01).In RAPN group,27 cases were clear-cell carcinoma,5 cases were papillary cell carcinoma,2 cases were chromophobe cell carcinoma and 1 1 cases were angioleiomyolipoma.In LPN group,45 cases were clear-cell carcinoma,9 cases were papillary cell carcinoma,3 cases were chromophobe cell carcinoma and 12 cases were angioleiomyolipoma.There was no difference of pathological types between LPN and RAPN groups (P＞0.05).The rate of positive surgical margins was 0％ (0/45) in RAPN group and 1.4％ (1/69) in LPN group (P=0.69).The rates of complication requiring intervention (Clavien grade Ⅲ) were 2.2％ (1/45) and 2.9％ (2/69) in the RAPN and LPN group,respectively (P＞0.05).Median follow up was 12 (4-36) months in the RAPN and 13 (5-34) months in the LPN group.No local recurrence or metastasis occurred in two groups.Conclusions Early comparative outcomes suggest that RAPN has a significant benefit over the LPN in terms of OT,WIT and hospital stay.Meanwhile,it offers equivalent prognosis and postoperative renal function preservation compared with LPN.