研究机器人辅助后腹腔镜肾脏内翻法背侧肾门肿瘤肾部分切除术的临床安全性和有效性。

回顾性总结我院2017年4月至2018年4月收治的背侧肾门肿瘤患者行机器人辅助后腹腔镜肾脏内翻法肾部分切除术的临床资料，并对手术步骤及结果进行总结。共计21例，其中男17例，女4例，年龄26～78岁，平均（53±14）岁，肾肿瘤均为单发，直径（2.5～8.0）cm，平均（4.3±1.7）cm，R. E. N. A. L评分6～12分，平均（9.4±1.5）分。取完全健侧卧位，术中于皱褶或薄弱处（Toldt’s线）切开腹膜：右侧向上至结肠肝曲，必要时切开三角韧带和肝结肠韧带；左侧向上至脾脏外上缘，必要时离断脾肾韧带和脾结肠韧带。向下至肾下极，使升结肠和结肠肝曲或脾和降结肠向腹侧中线移位。依次切断肾上、下极的脂肪组织分别至肾蒂血管、输尿管处，使患肾可轻易或自动向腹侧翻转，肿瘤及肾门得以充分显露，行常规肾部分切除及缝合。

所有患者均顺利完成手术，无中转开放或改根治性肾切除。镜下操作时间30～140 min，平均（80±24）min。术中出血量为20～500 ml，平均（104±115）ml。输自体血12例，无输异体血者。肾热缺血时间为8～34 min，平均（17±7）min。术后肛门排气时间平均35 h，应用止痛药3例。发生尿瘘1例，留置双J管引流治愈。无腹腔脏器损伤、感染及继发出血等并发症。病理结果：透明细胞癌15例，血管平滑肌脂肪瘤4例，乳头状癌1例，嗜酸细胞瘤1例，恶性肿瘤无切缘阳性。术后随访6～18个月，中位时间12个月，所有患者未见肿瘤复发或转移。

机器人辅助后腹腔镜背侧肾门肿瘤肾部分切除术，肾脏内翻法可使肿瘤和血管充分显露，便于操作，降低手术难度，安全有效。

To evaluate the clinical efficacy and safety of robot-assisted retroperitoneal laparoscopic partial nephrectomy using the renal inversion method for tumors located in the dorsal renal hilum.

Clinical data of patients with tumors located in the dorsal renal hilum undergoing robot-assisted retroperitoneal laparoscopic partial nephrectomy using renal inversion method in our hospital from April 2017 to April 2018 were retrospectively analyzed. Surgical procedures and outcomes were summarized. A total of 21 cases were enrolled, including 17 male and 4 female, aged from 26 to 78 years old, (53±14) years old on average. All patients were diagnosed with solitary renal tumors with a diameter of (2.5-8.0) cm, (4.3±1.7) cm on average. The R.E.N.A.L. score ranged from 6 to 12, (9.4±1.5) on average. Patients were placed in a lateral position on the normal side. Intraoperatively, the peritoneum was incised along the fold or thin site (the line of Toldt). It reached the colonic hepatic flexure on the right side, and the trigonal ligament and hepatocolonic ligament were incised when necessary and up to the superior margin of the spleen on the left side, and the ligaments of spleen and kidney and those of spleen and colon were separated when necessary. It reached downwards to the lower pole of the kidney, letting the ascending and colonic liver flexures or the spleen and descending colon shift to the ventral midline. The adipose tissues of the upper and lower poles of the kidney were successively cut off to the blood vessels of the renal pedicle and the ureters, making the affected kidney easily or automatically shift to the ventral side. The tumors and renal hilus could be fully exposed. Conventional partial nephrectomy and suturing were performed.

All patients successfully completed the surgery without conversion to open or radical nephrectomy. The laparoscopic operation time was 30-140 min, (80±24) min on average. The intraoperative bleeding volume was 20-500 ml with an average volume of (104±115) ml. Twelve patients received autologous blood transfusion, and no case received allogeneic blood transfusion. The duration of renal warm ischemia was 8-34 min, (17±7) min on average. The average time of anal exhaust was 35 h after operation. Three patients were administered with analgesics. One case developed urinary fistula and was cured by indwelling double J-tube drainage. No postoperative complications such as abdominal organ injury, infection and secondary hemorrhage occurred. Pathological examination showed 15 cases of clear cell carcinoma, 4 cases of angiomyolipoma, 1 case of papillary carcinoma and 1 case of oncocytoma. No positive margin was detected in the malignant tumors. All patients were subject to postoperative follow-up for 6 to 18 months, with a median time of 12 months. No tumor recurrence or metastasis was observed in all patients.

Robot-assisted retroperitoneal laparoscopic partial nephrectomy using the renal inversion method can fully expose the tumors and blood vessels of patients with tumors in the dorsal renal hilum. It is an efficacious and safe procedure and simple to operate, which can reduce the surgical difficulty.