机器人泌尿外科手术

1 IntroductionIn past few decades, better understandings of anatomy and advance in techniques and technology have revolutionized urological surgery. Laparoscopic surgery has now become one of the basic instruments of urologists. Laparoscopic radical nephrectomy is currently the standard of care in most urological centers.

后腹腔镜根治性肾切除术的临床应用

目的 探讨后腹腔镜根治性肾切除术的可行性、安全性及临床疗效.方法 2003年3月～2008年2月行后腹腔镜根治性肾切除术52例.男29例,女23例.年龄24～78岁,平均年龄57岁.右侧27例,左侧25例.无痛性全程肉眼血尿8例,其余44例为超声体检发现.肿瘤的大小1.5cm×1.8cm～8.7cm×9.2cm,平均3.6cm×4.3cm.肿瘤位于肾上极19例,肾中部15例,肾下极18例.52例均行CT检查.19例行MRI检查.术前临床分期:T1NOM05例,T2NOM045例,T3aNOM0 2例.结果 52例均获成功,无中转开放手术患者,有13例腹膜破裂、有6例术后肩部隐痛、有4例切口皮下气肿,病人均在短期恢复.术后均无使用镇痛剂.手术时间90～230min,平均152min;出血量50～200ml,平均120ml;术后住院时间6～9天,平均7.5天.术后病理报告:肾透明细胞癌49例,囊性肾细胞癌2例,肾颗粒细胞癌1例.随访6～36个月,平均15个月,未见肿瘤复发.结论 后腹腔镜根治性肾切除术安全可行、疗效肯定.

The reporting of complications fol owing transperitoneal and retroperitoneal open radical nephrectomy (RN) is nonstandardized. This study aimed to compare early complications between the two approaches using a standardized reporting methodology in a large contemporary cohort. Between 1996 and 2009, 558 patients underwent open RN for renal cel carcinoma (RCC) in our two centers (424 from Sun Yat-sen University Cancer Center and 134 from the First Affiliated Hospital of Sun Yat-sen University). Records were reviewed for clinicopathologic features and complications. Complications were graded using the Clavien system based on the severity of impact. One hundred and five patients (18.8%) had one or more early complications (168 complications overal ). The overal rates of grades I to V complications were 5.6%, 10.8%, 2.2%, 0.4%, and 0.2%, respectively. Patients who underwent transperitoneal RN did not experience more overal or procedure-related complications than those who underwent retroperitoneal RN (P=0.911 and P=0.851, respectively). On subgroup analysis, neither grade I/II nor grades III-V complications were significantly different between the transperitonal RN and retroperitoneal RN groups. Multivariate analysis showed that for any grade of complication, age (P = 0.016) and estimated blood loss (P = 0.001) were significant predictors. We concluded that open RN is a safe procedure associated with low rates of serious morbidity and mortality. Compared with retroperitoneal RN, transperitoneal RN was not associated with more complications. Older patient and more blood loss at surgery were independent predictors for higher early postoperative complication rates.