机器人辅助腹腔镜肾分支动脉分步阻断保留肾单位手术在治疗巨大复杂肾癌中的应用

doi:10.3877/cma.j.issn.1674-3253.2021.02.001

中华腔镜泌尿外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (02) : 89 -92. doi: 10.3877/cma.j.issn.1674-3253.2021.02.001

所属专题：文献；

临床研究

机器人辅助腹腔镜肾分支动脉分步阻断保留肾单位手术在治疗巨大复杂肾癌中的应用

陈旭¹, 韦锦焕¹, 周航¹, 陈炜¹, 罗俊航¹^,^†(

)

^1. 510080　广州，中山大学附属第一医院泌尿外科

收稿日期:2020-11-19 出版日期:2021-04-01
通信作者: 罗俊航

Gradually clamping of renal branch arteries in robot-assisted laparoscopic nephron sparing surgery for large complex kidney tumor

Xu Chen¹, Jinhuan Wei¹, Hang Zhou¹, Wei Chen¹, Junhang Luo¹^,^†()

^1. Department of Urology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China

Received:2020-11-19 Published:2021-04-01
Corresponding author: Junhang Luo

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目的

巨大复杂肾癌的保肾手术难点在于既要完整切除巨大肿瘤，确切缝合大而深的创面及肾脏重建，同时又要避免肾脏热缺血时间过长。本文报告应用肾动脉分级阻断分步开放的优化肾血管阻断技术并结合机器人辅助腹腔镜操作精细分离和缝合的优势，较好地解决了这一难题，为此类复杂手术提供新思路。

方法

我院对一例56岁男性T2期R.E.N.A.L评分11分的巨大复杂肾癌患者运用机器人辅助下肾动脉分级阻断分步开放技术成功实施肾部分切除术。

结果

手术顺利完成，术后随访1个月和半年，复查患肾形态恢复，肾功能正常，未见肿瘤复发。

结论

对巨大复杂肾癌可利用机器人辅助肾动脉分级阻断分步开放技术实现在保证肿瘤完整切除基础上，最大程度减少肾热缺血时间，减少围术期并发症发生，具有临床推广应用价值。

关键词: 肾肿瘤, 肾动脉阻断, 保留肾单位手术, 机器人, 腹腔镜, 三维重建

Objective

The difficulty of nephron sparing surgery for large and complex kidney tumor lies in removing tumor completely and reconstructing of large and deep wounds precisely in limited renal ischemia time. The article reported that the experiences of utilizing gradually clamping renal branch arteries by robot-assisted laparoscopic surgery to solve the problem, providing a de-novo option for such kind of complicate operation.

Methods

Partial nephrectomy was performed on a case of 56-year-old man with a T2 stage, R.E.N.A.L score of 11 renal tumor by using robot-assisted laparoscopic gradually clamping renal branch arteries surgery technique.

Results

The operation was successfully completed, and organ shape mostly recovered along with normal renal function and no tumor recurrence in one month and halfa year postoperative follow up.

Conclusion

Gradually clamping of renal branch arteries in robot-assisted laparoscopic nephron sparing surgery can be used for large and complex renal mass to ensure complete tumor resection, minimize renal ischemia time and reduce perioperative complications, which deserving the clinical expansion application.

Key words: Renal tumor, Renal artery clamping, Nephron sparing surgery, Robot, Laparoscopy, 3D-reconstruction

图2 术前肿瘤三维重建图和术中动脉阻断图

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Gradually clamping of renal branch arteries in robot-assisted laparoscopic nephron sparing surgery for large complex kidney tumor