单机位机器人辅助腹腔镜下肾盂癌根治术治疗肾盂肿瘤的效果观察

魏海彬; 缪嘉; 张琦; 钱麟; 李恩惠; 许晓波; 吕佳; 刘锋; 祁小龙; 张大宏

doi:10.16766/j.cnki.issn.1674-4152.002271

单机位机器人辅助腹腔镜下肾盂癌根治术治疗肾盂肿瘤的效果观察

doi: 10.16766/j.cnki.issn.1674-4152.002271

魏海彬^{1, 2},
缪嘉²,
张琦¹,
钱麟²,
李恩惠¹,
许晓波¹,
吕佳¹,
刘锋¹,
祁小龙¹,
张大宏^1, ,

1.
浙江省人民医院杭州医学院附属人民医院泌尿外科，浙江杭州 310014
2.
浙江中医药大学第二临床医学院，浙江杭州 310053

基金项目:

浙江省自然科学基金面上项目 LY15H160052

浙江省医药卫生科技项目面上项目 2020KY401

详细信息

通讯作者:
张大宏，E-mail: zhangdahong88@yeah.net

中图分类号: R737.11 R730.56
计量
- 文章访问数: 306
- HTML全文浏览量: 171
- PDF下载量: 8
- 被引次数: 0
出版历程
- 收稿日期: 2020-03-05
- 网络出版日期: 2022-03-03

Clinical observation of single-docking robot-assisted laparoscopic radical nephroureterectomy for renal pelvic carcinoma

1.
Department of Urology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, China

摘要

摘要: 目的评估单机位机器人辅助腹腔镜下肾盂癌根治术治疗肾盂肿瘤的临床疗效及安全性。方法回顾性分析2014年9月—2018年9月浙江省人民医院收治的42例肾盂肿瘤患者病例资料。其中男性27例，女性15例，均采用达芬奇机器人Si系统辅助腹腔镜下肾盂癌根治术。观察孔位于腹正中线患侧旁开6~8 cm平脐位置，1号臂、2号臂分别于旁开线上观察孔两侧，距观察孔8 cm，在观察孔径线呈对称分布。记录手术时间、术中估计出血量、术后并发症等情况。所有患者随访12~48个月，记录肿瘤复发情况。结果所有手术均一次顺利完成，均未中转普通腹腔镜或开放手术。术中估计出血量为90(50，260)mL，手术时间为140(100，205)min，术后住院时间为8(6，12)d。术后病理均证实肾盂恶性肿瘤，临床病理分级Ⅰ级患者16例，Ⅱ级17例，Ⅲ级4例，Ⅳ级5例。15例患者(35.7%)进行淋巴结清扫，清扫淋巴结中位数为14(4，24)枚，有5例患者淋巴结阳性。术后并发症发生率：Clavien 2级发生率为9.5%(2例患者需输血，另2例肺部感染，需行抗感染治疗)；Clavien 3级并发症的发生率为4.8%(2例患者因胸腔积液行穿刺闭式引流)。并发症的发生率总体较低。术后中位随访时间为16.5个月。随访期内有3例患者膀胱内肿瘤种植复发，而行经尿道膀胱肿瘤电切术。结论单机位机器人辅助腹腔镜肾盂癌根治术是治疗肾盂肿瘤一种安全有效的微创手术方法，具有操作空间大、上下兼顾、操作便利等优点。
- 机器人 /
- 腹腔镜 /
- 肾盂癌根治术 /
- 疗效
Abstract: Objective To evaluate the clinical efficacy and safety of single-docking technique for robot-assisted laparoscopic radical nephroureterectomy in the treatment of renal pelvic carcinoma. Methods Total 42 consecutive patients with renal pelvic carcinoma were enrolled for the retrospective study in our hospital from September 2014 to September 2018. There were 27 male and 15 female patients. All patients were underwent Da Vinci Si robot-assisted laparoscopic radical nephroureterectomy. The robotic camera port was placed in the affected side 6-8 cm beside the abdominal midline at the level of the umbilicus. The No. 1 robotic port and the No. 2 robotic port were respectively located parallel to the abdominal midline and 8 cm from the camera port. They were symmetrically distributed to the camera port line. The operative time, perioperative blood loss and postoperative complications were recorded. All patients were followed up for 12-48 months, and tumour recurrence was recorded. Results All operations were successfully completed, without transition to laparoscopic or open surgery. The blood loss was 90 (50, 260) mL, the operating time was 140 (100, 205) min, and the postoperative hospital stay was 8 (6, 12) days. Postoperative pathology confirmed renal pelvic malignant tumours, 16 cases of grade Ⅰ, 17 cases of grade Ⅱ, 4 cases of grade Ⅲ and 5 cases of grade Ⅳ. In 15 patients (35.7%), lymphadenectomy was performed with mean lymph node count of 14 (4, 24), and 5 patients were positive for lymph nodes. Postoperative complication rate: the incidence rate of Clavien grade 2 was 9.5% (2 patients required blood transfusion, 2 other patients with lung infections required anti-infective treatment), Clavien grade 3 complications occurred in 4.8% of patients (2 patients underwent thoracic drainage because of pleural effusion). The incidence of complications was generally low. The median follow-up time was 16.5 months. During the follow-up period, 3 patients had intravesical tumour recurrence and transurethral resection of bladder tumour. Conclusion Single-docking technique for robot-assisted laparoscopic radical nephroureterectomy is a safe and effective minimally invasive procedure with the advantages of larger operation space and more convenient operation for the treatment of renal pelvic carcinoma.
- Robot /
- Laparoscopy /
- Nephroureterectomy /
- Outcome

HTML全文

图 1 左侧肾盂癌术中体位及机器臂位置

注：图A示术中体位，1、2分别为机器人1号臂、2号臂的Trocar入位位置；图B示机器臂位置。

下载: 全尺寸图片幻灯片

图 2 右侧肾盂癌术中体位及机器臂位置

注：A示术中体位，1、2分别为机器人1号臂、2号臂的Trocar入位位置；B示机器臂位置。

下载: 全尺寸图片幻灯片

图 3 术中病理标本及剖面

注：A为肾盂肿瘤及剖面；B为输尿管袖套。

下载: 全尺寸图片幻灯片

表 1 42例肾盂癌患者术后病理

病理	例(%)	病理	例(%)
TNM分期		预后分期
T1N0M0	16(38.1)	Ⅰ	16(38.1)
T2N0M0	17(40.5)	Ⅱ	17(40.5)
T3N0M0	4(9.5)	Ⅲ	4(9.5)
T3N1M0	3(7.1)	Ⅳ	5(11.9)
T3N2M0	2(4.8)
注：根据AJCC肿瘤分期手册(第8版)。

下载: 导出CSV

参考文献(16)

[1]	SIEGEL R L, MILLER K D, JEMAL A. Cancer statistics, 2018[J]. CA Cancer J Clin, 2018, 68(1): 7-30. doi: 10.3322/caac.21442
[2]	ATTALLA K, PATNAIK S, VELLOS T, et al. Management of distal ureter and bladder cuff at the time of nephroureterectomy: Surgical techniques and predictors of outcome[J]. Future Oncol, 2019, 15(20): 2385-2393. doi: 10.2217/fon-2019-0064
[3]	LIN V C, CHEN C H, CHIU A W. Laparoscopic nephroureterectomy for upper tract urothelial carcinoma-Update[J]. Asian J Urol, 2016, 3(3): 115-119. doi: 10.1016/j.ajur.2016.05.003
[4]	WEI H B, QI X L, LIU F, et al. Robot-assisted laparoscopic reconstructed management of multiple aneurysms in renal artery primary bifurcations: A case report and literature review[J]. BMC Urol, 2017, 17(1): 96-100. doi: 10.1186/s12894-017-0265-8
[5]	MORGAN R, BABJUK M, EVA C, et al. European association of urology guidelines on upper urinary tract urothelial carcinoma: 2017 update[J]. Eur Urol, 2018, 73(1): 111-122. doi: 10.1016/j.eururo.2017.07.036
[6]	LIU F, GUO W, ZHOU X, et al. Laparoscopic versus open nephroureterectomy for upper urinary tract urothelial carcinoma: A systematic review and meta-analysis[J]. Medicine (Baltimore), 2018, 97(35): e11954. doi: 10.1097/MD.0000000000011954
[7]	ZAMBONI S, FOERSTER B, ABUFARAJ M, et al. Incidence and survival outcomes in patients with upper urinary tract urothelial carcinoma diagnosed with variant histology and treated with nephroureterectomy[J]. BJU Int, 2019, 124(5): 738-745. doi: 10.1111/bju.14751
[8]	PEYRONNET B, SEISEN T, DOMINGUEZ-ESCRIG J L, et al. Oncological outcomes of laparoscopic nephroureterectomy versus open radical nephroureterectomy for upper tract urothelial carcinoma: An European association of urology guidelines systematic review[J]. Eur Urol Focus, 2019, 5(2): 205-223. doi: 10.1016/j.euf.2017.10.003
[9]	GULAMHUSEIN A, SILVA P, CULLEN D, et al. Safety and feasibility of early single-dose mitomycin C bladder instillation after robot-assisted radical nephroureterectomy[J]. BJU Int, 2020, 126(6): 739-744. doi: 10.1111/bju.15162
[10]	PATEL M N, ABOUMOHAMED A, HEMAL A. Does transition from the da Vinci Si to Xi robotic platform impact single-docking technique for robot-assisted laparoscopic nephroureterectomy?[J]. BJU Int, 2015, 116(6): 990-994. doi: 10.1111/bju.13210
[11]	TAYLOR B L, SCHERR D S. Robotic nephroureterectomy[J]. Urol Clin North Am, 2018, 45(2): 189-197. doi: 10.1016/j.ucl.2017.12.004
[12]	PATHAK R A, HEMAL A K. Techniques and outcomes of robot-assisted nephro-ureterectomy for upper tract urothelial carcinoma[J]. Eur Urol Focus, 2018, 4(5): 657-661. doi: 10.1016/j.euf.2018.08.007
[13]	DE G R, DECAESTECKER K, LARCHER A, et al. Robot-assisted nephroureterectomy for upper tract urothelial carcinoma: Results from three high-volume robotic surgery institutions[J]. J Robot Surg, 2020, 14(1): 211-219. doi: 10.1007/s11701-019-00965-8
[14]	VECCIA A, ANTONELLI A, FRANCAVILLA S, et al. Robotic versus other nephroureterectomy techniques: A systematic review and meta-analysis of over 87, 000 cases[J]. World J Urol, 2020, 38(4): 845-852. doi: 10.1007/s00345-019-03020-1
[15]	夏灿灿, 杨洋, 江志伟, 等. 1例达芬奇机器人下行胃癌根治术后48h内出院患者的护理[J]. 中华全科医学, 2016, 14(11): 1962-1964. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201611055.htm
[16]	PAI A, HUSSAIN M, HINDLEY R, et al. Long-Term Outcomes of laparoscopic nephroureterectomy with transurethral circumferential excision of the ureteral orifice for urothelial carcinoma[J]. J Endourol, 2017, 31(7): 651-654. doi: 10.1089/end.2017.0049