浏览全部资源
扫码关注微信
根治性肾切除联合下腔静脉癌栓取出机器人辅助与开放手术的临床疗效对比
Clinical efficacy of robot-assisted laparoscopic versus open radical nephrectomy plus inferior vena cava thrombectomy
- 陆军军医大学学报 2023年45卷第20期 页码：2099-2105
- 作者机构：
400042 重庆，陆军特色医学中心泌尿外科
- 作者简介：
[江军，E-mail: jiangjun_64@163.com JIANG Jun, E-mail: jiangjun_64@163.com
- 基金信息：国家自然科学基金面上项目(82172807);国家自然科学基金面上项目(81972398);陆军军医大学科研项目(2018XLC1014);陆军军医大学科研项目(2019CXLCB006);陆军军医大学专项研究项目(2021XQN24)
DOI：10.16016/j.2097-0927.202208120
中图分类号： R730.56;R732.22;R737.11收稿：2022-08-08，
修回：2022-09-14，
纸质出版：2023-10-30
- 稿件说明：
移动端阅览
严旭芝, 王硕, 刘秋礼, 等. 根治性肾切除联合下腔静脉癌栓取出机器人辅助与开放手术的临床疗效对比[J]. 陆军军医大学学报, 2023,45(20):2099-2105.
Xuzhi YAN, Shuo WANG, Qiuli LIU, et al. Clinical efficacy of robot-assisted laparoscopic versus open radical nephrectomy plus inferior vena cava thrombectomy[J]. Journal of Army Medical University, 2023, 45(20): 2099-2105.
严旭芝, 王硕, 刘秋礼, 等. 根治性肾切除联合下腔静脉癌栓取出机器人辅助与开放手术的临床疗效对比[J]. 陆军军医大学学报, 2023,45(20):2099-2105. DOI： 10.16016/j.2097-0927.202208120.
Xuzhi YAN, Shuo WANG, Qiuli LIU, et al. Clinical efficacy of robot-assisted laparoscopic versus open radical nephrectomy plus inferior vena cava thrombectomy[J]. Journal of Army Medical University, 2023, 45(20): 2099-2105. DOI： 10.16016/j.2097-0927.202208120.
摘要
目的
2
总结机器人辅助腹腔镜下根治性肾切除(robot-assisted laparoscopic radical nephrectomy
RARN)联合下腔静脉癌栓取出术和开放根治性肾切除(open radical nephrectomy
ORN)联合下腔静脉癌栓取出术的手术技巧和临床经验，比较两种术式的临床效果及安全性。
方法
2
采用回顾性队列研究设计方案，收集2012年1月至2022年12月我院收治的26例行根治性肾切除联合下腔静脉癌栓取出术的肾脏肿瘤伴下腔静脉瘤栓患者的临床资料。其中开放手术12例(3例采用体外循环)；机器人辅助下手术14例(2例中转开放)。对比分析2种手术方式的手术时间、术中腔静脉阻断时间、术中失血量、术中输血率、术后转ICU率、术后住院时间等临床手术特征的差异。
结果
2
26例患者手术平均时间(394±141) min。除3例体外循环外，术中阻断腔静脉时间(23.90±6.95) min。将12例机器人辅助下手术与9例开放手术纳入数据分析：两组患者年龄、体质指数(BMI)、原发肿瘤最大直径、肿瘤T分期和Mayo分级等无显著性差异。机器人辅助下手术的术中失血量中位值为600(50~1 600) mL，明显少于开放手术术中失血量1 100 (600~3 800) mL，差异有统计学意义(
P
=0.049)；机器人辅助下手术的手术时间为(323±102) min，开放手术时间为(401±95) min(
P
=0.089)；机器人辅助下手术的术中腔静脉平均阻断时间为(26.10±7.03) min，开放手术的时间为(20.20±6.16) min(
P
=0.057)；两组间术中输血率差异无统计学意义(8/12
vs
8/9，
P
=0.338)；机器人辅助下手术的术后转ICU率为3/12，开放手术的为6/9(
P
=0.087)；机器人辅助下手术的术后住院时间中位值为7(4~14) d，开放手术为8(7~20) d(
P
=0.091)。
结论
2
机器人辅助腹腔镜下根治性肾切除联合下腔静脉癌栓取出术安全、有效；较之开放手术术中出血明显更少。
Abstract
Objective
2
To summarize our surgical techniques and clinical experience of robot-assisted laparoscopic radical nephrectomy (RARN) and open radical nephrectomy (ORN) plus inferior vena cava thrombectomy (IVCT)
and compare the clinical outcomes and safety of the 2 procedures.
Methods
2
A retrospective cohort study was conducted on 26 patients diagnosed with renal tumor complicated with inferior vena cava tumor thrombus who underwent radical nephrectomy plus inferior vena cava thrombectomy in our department from 2012 to 2022. Among them
12 patients were conducted with ORN plus IVCT (O-IVCT)
including 3 cases having cardiopulmonary bypass
and the other 14 patients received RARN plus IVCT (RA-IVCT)
of them 2 cases experienced conversion to open surgery. Surgical characteristics
such as operative time
intraoperative duration for blocking the vena cava
intraoperative bleeding volume
postoperative length of hospital stay and rates of intraoperative blood transfusion and postoperative conversion to ICU were compared between the 2 groups.
Results
2
The average operative time was 394±141 min in all cases
and the time of blocking the inferior vena cava was 23.90±6.95 min excluding 3 cases undergoing cardiopulmonary bypass. There were no significantly differences in the average age
body mass index (BMI)
tumor size
pathological T stage
or tumor thrombus level by Mayo classification between the RA-IVCT and O-IVCT group. The patients from the RA-IVCT group had a median intraoperative bleeding volume of 600 (50~1 600) mL
significantly less than that in the O-IVCT group [1 100 (600~3 800) mL
P
=0.049
]
. No statistical differences were observed between the RA-IVCT group
and O-IVCT group in following indicators: mean operative time (323±102
vs
401±95 min
P
=0.089)
mean duration of blocking the inferior vena cava (26.10±7.03
vs
20.20±6.16 min
P
=0.057)
rate of blood transfusion (8/12
vs
8/9
P
=0.338)
rate of ICU admission (3/12
vs
6/9
P
=0.087)
or median length of hospital stay after surgery [7(4~14)
vs
8(7~20) d
P
=0.091
]
.
Conclusion
2
RA-IVCT is a safe and effective operation
with the advantage of less intraoperative bleeding volume when compared with O-IVCT.
关键词
Keywords
references
KIM H L, ZISMAN A, HAN K R, et al . Prognostic significance of venous thrombus in renal cell carcinoma. Are renal vein and inferior vena cava involvement different? [J ] . J Urol, 2004, 171(2 Pt 1): 588-591. DOI: 10.1097/01.ju.0000104672.37029.4b.
DOMINIK J, MORAVEK P, ZACEK P, et al . Long-term survival after radical surgery for renal cell carcinoma with tumour thrombus extension into the right atrium[J ] . BJU Int, 2013, 111(3 Pt B): E59-E64. DOI: 10.1111/j.1464-410X.2012.11515.x.
CIANCIO G, MANOHARAN M, KATKOORI D, et al . Long-term survival in patients undergoing radical nephrectomy and inferior vena cava thrombectomy: single-center experience[J ] . Eur Urol, 2010, 57(4): 667-672. DOI: 10.1016/j.eururo.2009.06.009.
ABAZA R. Initial series of robotic radical nephrectomy with vena caval tumor thrombectomy[J]. Eur Urol, 2011, 59(4): 652-656. DOI: 10.1016/j.eururo.2010.08.038.
WANG B J, LI H Z, MA X, et al . Robot-assisted laparoscopic inferior vena cava thrombectomy: different sides require different techniques[J ] . Eur Urol, 2016, 69(6): 1112-1119. DOI: 10.1016/j.eururo.2015.12.001.
WANG B J, HUANG Q B, LIU K, et al . Robot-assisted level Ⅲ-Ⅳ inferior vena cava thrombectomy: initial series with step-by-step procedures and 1-yr outcomes[J ] . Eur Urol, 2020, 78(1): 77-86. DOI: 10.1016/j.eururo.2019.04.019.
WANG B J, LI H Z, HUANG Q B, et al . Robot-assisted retrohepatic inferior vena cava thrombectomy: first or second Porta hepatis as an important boundary landmark[J ] . Eur Urol, 2018, 74(4): 512-520. DOI: 10.1016/j.eururo.2017.11.017..
GU L Y, MA X, GAO Y, et al . Robotic versus open level Ⅰ-Ⅱ inferior vena cava thrombectomy: a matched group comparative analysis[J ] . J Urol, 2017, 198(6): 1241-1246. DOI: 10.1016/j.juro.2017.06.094.
ROSE K M, NAVARATNAM A K, FARAJ K S, et al . Comparison of open and robot assisted radical nephrectomy with level Ⅰ and Ⅱ inferior vena cava tumor thrombus: the Mayo clinic experience[J ] . Urology, 2020, 136: 152-157. DOI: 10.1016/j.urology.2019.11.002.
VUONG N S, FERRIERE J M, MICHIELS C, et al . Robot-assisted versus open surgery for radical nephrectomy with level 1-2 vena cava tumor thrombectomy: a French monocenter experience (UroCCR study #73)[J ] . Minerva Urol Nephrol, 2021, 73(4): 498-508. DOI: 10.23736/S2724-6051.20.04052-7.
BEKSAC A T, SHAH Q N, PAULUCCI D J, et al . Trends and outcomes in contemporary management renal cell carcinoma and vena cava thrombus[J ] . Urol Oncol, 2019, 37(9): 576. e17-576.576. e23. DOI:10.1016/j.urolonc.2019.05.010.
0
浏览量
0
下载量
0
CSCD
- 网络PDF下载
- Meta-XML下载
- BibTeX下载
- Endnote下载
- RefMan 下载
- NoteExpress下载
- NoteFirst下载
关联资源
相关文章
相关作者
相关机构
- 技术支持由北京北大方正电子有限公司提供 京ICP备09064830号-19
京公网安备11010802024621 - 本系统建议在Chrome、 IE9+ 以上版本浏览器阅读本站内容，360浏览器请切换至极速模式
- Cookies帮助我们提供服务并提供个性化体验。使用本网站，即表示您同意我们使用Cookies
