目的

随着机器人微创技术的不断发展，保肾手术的适应证逐步扩大到T_2a和T_2b期等巨大复杂肾肿瘤，但巨大肿瘤分离时因暴露困难常出现手术器械严重挤压肿瘤的情况，本文探索逆行切除技术解决这一难题的可行性。

方法

回顾性分析中山大学附属第一医院收治的2例巨大复杂肾癌患者的临床资料，2例均为男性，病例一35岁，临床分期为T_2aN₀M₀，CT示左肾上极最大径7.2 cm囊性肾癌；病例二41岁，临床分期为T_2bN₀M₀，CT示右肾上极最大径10.8 cm囊实性肾癌。在机器人辅助腹腔镜肾部分切除术中采用逆行切除，在不挤压巨大肾肿瘤的前提下，先分离肿瘤与正常肾实质交界处，在完成肾部分切除手术后再游离远离正常肾实质交界的肿瘤。

结果

两例肾癌在机器人辅助腹腔镜肾部分切除术中应用了逆行切除技术，手术过程顺利，病例一和二手术时间分别为188 min、215 min，热缺血时间分别为23 min、15 min（热缺血时间二为33 min），未出现手术或术后并发症，术后病理均为肾透明细胞癌，定期随访未发现肿瘤复发或转移。

结论

逆行切除技术在巨大复杂肾癌的机器人辅助腹腔镜肾部分切除术中方便易行，与常规方式相比，不需要严重挤压肿瘤就可以把巨大肿瘤完整切除，避免肿瘤种植转移风险，更符合手术无瘤操作原则。

Objective

With the continuous development of robotic minimally invasive technology，the indications for nephron-sparing surgery have gradually expanded to include large and complex renal tumors at T_2a and T_2b stages. However， during the dissection of large tumors， the difficulty of exposure often leads to significant compression of the tumor by surgical instruments. This study explores the feasibility of the retrograde resection technique to address this issue.

Methods

A retrospective analysis was conducted on the clinical data of 2 patients with large complex renal cancer admitted to the First Affiliated Hospital of Sun Yat-sen University. Both patients were male. Case 1 was 35 years old with clinical staging of T_2aN₀M₀ and a CT scan showing a 7.2 cm cystic renal tumor in the upper pole of the left kidney， case 2 was 41 years old with clinical staging of T_2bN₀M₀ and a CT scan showing a 10.8 cm cystic-solid renal tumor in the upper pole of the right kidney. In robotic-assisted laparoscopic partial nephrectomy， the retrograde resection technique was employed to avoid compressing the large renal tumor by first separating the tumor from the normal renal parenchyma at the interface， and then freeing the tumor away from the normal renal parenchyma after completing the partial nephrectomy.

Results

The retrograde resection technique was applied in the two cases of renal cancer during robotic-assisted laparoscopic partial nephrectomy. The surgeries were performed smoothly， with operation time of 188 minutes and 215 minutes， and warm ischemia time of 23 minutes and 15 minutes （the second warm ischemia time was 33 minutes）， respectively. No intraoperative or postoperative complications occurred， and postoperative pathology confirmed both cases as renal clear cell carcinoma.Regular follow-up showed no recurrence or metastasis of the tumors.

Conclusions

The retrograde resection technique is convenient and feasible in robotic-assisted laparoscopic partial nephrectomy for large complex renal cancers. Compared to conventional methods， it allows for complete resection of large tumors without significant compression， reducing the risk of tumor implantation and metastasis， and aligns with the principle of tumor-free surgical operation.