机器人辅助、3D及传统腹腔镜在保留 肾单位手术中的对比研究

Comparison of robot-assisted, 3D and traditional laparoscopic nephron sparing surgery

摘要:

目的 比较机器人辅助腹腔镜肾部分切除术（RAPN）、3D腹腔镜（3D）及传统腹腔镜（LPN）在肾肿瘤保留肾单位手术的疗效和临床使用价值。方法 回顾性分析该院2012年8月－2015年4月收治的腹腔镜保留肾单位手术90例肾肿瘤患者的临床资料，其中RAPN组21例、3D组30例和LPN组39例。比较3组手术时间、热缺血时间、术中出血量、引流管引流量、术后住院时间、住院费用及术后并发症情况的差异。结果 3组手术时间分别为（129.0±13.9）、（123.9±18.7）和（137.0±22.1）min，3D组与LPN组差异有统计学意义（P < 0.05），RAPN组和3D组、LPN组差异无统计学意义（P >0.05）；热缺血时间分别为（18.1±5.1）、（22.2±6.5）和（25.7±5.4）min，3组间差异均有统计学意义（P <0.05）；住院费用分别为（46 858.3±3 057.2）、（21 904.8±2 404.3）和（21 019.7±1 478.9）元，RAPN组与3D组、LPN组差异有统计学意义（P <0.05），3D组和LPN组差异无统计学意义（P >0.05）；术中出血量、引流管引流量、术后住院时间各组间差异均无统计学意义（P >0.05）；3D组1例切口延迟愈合，LPN组1例切口延迟愈合和2例肾周血肿，保守治疗后均治愈，3组手术切缘均阴性；随访1～32个月，未见复发和转移，肾功能正常。结论 传统腹腔镜推广简单且费用少；3D腹腔镜的三维视野和经济性的优势有着广阔的应用前景；机器人辅助腹腔镜手术操作最灵活，将成为未来医学发展的主流术式。

Abstract:

【Objective】 To compare clinical outcomes of robot-assisted laparoscopic, 3D laparoscopic and traditional laparoscopic nephron sparing surgery (NSS). 【Methods】 From March 2012 to April 2015, 90 patients underwent laparoscopic nephron sparing surgery in our hospital due to renal carcinoma, including robot-assisted laparoscopic NSS in 21 patients, 3D laparoscopic NSS in 30 patients and traditional laparoscopic NSS in 39 patients. Their data were retrospectively reviewed. 【Results】 The operative time were (129.0 ± 13.9) min, (123.9 ± 18.7) min and (137.0 ± 22.1) min, respectively. There was significant difference between 3D group and LPN group, while no significant difference was found between RAPN group, 3D group and LPN group (P > 0.05). The renal warm ischemia time was (18.1 ± 5.1) min, (22.2 ± 6.5) min and (25.7 ± 5.4) min, respectively. There was significant difference between each group (P < 0.05). The total hospitalization charge was (46 858.3 ± 3 057.2), (21 904.8 ± 2 404.3) and (21 019.7 ± 1 478.9), respectively. There was significant difference between RARP group, 3D group and LPN group, while no significant difference was found between 3D group and LPN group (P > 0.05). However, the estimated blood loss,volume of drainage and postoperative hospital stay were similar between the 3 groups (P > 0.05). Each 1 case of 3D and LPN group was found delayed wound healing, and another 2 cases of peri-renal hematoma were also noticed in LPN group. All complications were cured; Follow-up ranged from 1 to 32 months, no tumor recurred and/or metastasis developed. All resection margins were negative. 【Conclusions】 Traditional laparoscopy was easy to apply and economic; 3D three-dimensional vision and low price has broad application prospects in 3D laparoscopy; the flexible surgical action of robot-assisted laparoscopic NSS make it the main method in the future of medical development.