全息影像技术在机器人辅助腹腔镜下肾部分切除术治疗肾门部肿瘤中的应用

Application of holography in treatment of renal hilar tumor by robot-assisted laparoscopic partial nephrectomy

摘要:

摘要：目的??评价全息影像技术引导机器人辅助腹腔镜下肾部分切除术（RAPN）治疗肾门部肿瘤的可行性与有效性。方法 回顾性分析该院2019年6月－2019年10月收治的11例肾门部肿瘤患者的临床资料。其中，男3例，女8例；左侧4例，右侧7例；患者年龄32～75岁，平均62.6岁，体质指数19.45～28.12?kg/m2，平均23.75?kg/m2，肿瘤直径1.1～6.7?cm，平均2.76?cm，R.E.N.A.L.评分8～12分，平均10.7分，患肾肾小球滤过率（GFR）22～51?mL/min，平均35?mL/min。患者术前行全腹部增强CT，利用CT数据进行全息影像重建。术中应用该技术结合达芬奇机器人辅助系统，精准分离、剜除肿瘤，并记录手术持续时间、出血量、肾脏热缺血时间、有无并发症及切缘阳性率等。结果 根据全息影像引导，11例患者均顺利剜除肿瘤，完成手术，无中转开放。手术时间60～130?min，平均90?min。术中出血量50～180?mL，平均100?mL，热缺血时间18～25?min，平均21?min，无术后发热、继发出血或漏尿等并发症。术后病理诊断肾透明细胞癌9例（FuhrmanⅠ和Ⅱ级），乳头状细胞癌1例，血管平滑肌脂肪瘤1例，无切缘阳性病例。术后随访3～7个月，平均4.3个月，患肾GFR 18～43?mL/min，平均31?mL/min。术后3个月复查肾脏CT平扫及增强，全部患者未出现复发。结论 全息影像技术引导RAPN治疗肾门部肿瘤，围手术期并发症少，安全有效。

Abstract:

Abstract: Objective?To evaluate the feasibility and effectiveness of holographic image navigation in robot-assisted laparoscopic partial nephrectomy (RAPN) for renal hilar tumors.?Methods?The clinical data of 11 patients who underwent RAPN for renal hilar tumors with holography during June to October of 2019 were respectively analyzed. There were 3 males and 8 females with an average age of 62.6 years (range 32 to 75 years), the average body mass index of 23.75?kg/m2 (range 19.45 to 28.12?kg/m2), 4 cases of left and 7 cases of right renal tumors. The average tumor diameter was 2.76?cm (range 1.1 to 6.7?cm). The mean GFR is 35?mL/min (range 22 to 51?mL/min). The R.E.N.A.L. score was 10.7 (range 8 to 12). Holography based on enhanced CT data was applied for the purpose of precise separation, enucleation the tumor with the Da Vinci robot-assisted system. The operative time, warm ischemia time, intraoperative blood loss, complications, and oncologic outcomes were analyzed.?Results?According to the holographic image, all operations were completed successfully and there was no open conversion and large vessel injury. The average operation time was 90 min (60?~?130 min), estimated blood loss was 100?mL (50?~?180?mL), warm ischemic time was 21 min (18?~?25 min), There was no postoperative fever, secondary blood loss, urine leakage or other complications. Pathologically, there were 9 cases of clear cell renal cell carcinoma (Fuhrman grade Ⅰ?~?Ⅱ), 1 case of papillary renal cell carcinoma, and 1 case of angioleiomyolipoma, Surgical margins were negative for malignancy in all cases. At a mean follow-up period of 4.3 months, the mean GFR is 31?mL/min (range 18 to 43?mL/min) without any disease recurrence.?Conclusions?It is safe and effective for renal hilar tumors to use holographic image navigation in robot-assisted laparoscopic partial nephrectomy, which has less perioperative complications.