机器人辅助复杂肾部分切除术实用手术技术与展望

doi:10.3877/cma.j.issn.1674-3253.2026.01.004

肾癌作为全球范围内常见的泌尿系统恶性肿瘤，其治疗策略在近年来经历了显著的演变。随着微创手术技术的发展，机器人辅助手术系统已成为肾部分切除术中的重要工具。本文论述了机器人辅助技术在肾癌部分切除术中的应用，总结了其技术优势、实用技巧、临床效果、面临的挑战以及未来的发展方向。

关键词: 机器人辅助, 肾癌, 肾部分切除

Renal cell carcinoma (RCC), a prevalent urological malignancy globally, has seen significant shifts in its therapeutic strategies in recent years. With advancements in minimally invasive surgery, robotic-assisted systems have become crucial tools in partial nephrectomy for RCC. This review discusses the use of robotic technology in RCC partial nephrectomy, summarizing its advantages, practical techniques, clinical efficacy, challenges, and future perspectives.

Key words: Robotic-assisted, Renal cell carcinoma, Partial nephrectomy

图1 复杂肾肿瘤部分切除术层次分离及组织剥离技巧示意图注：a为肾周围解剖示意图；b为融合筋膜的剥离线；c psoas窗为腰大肌位置；d为肾门部软组织剥离前；e为肾门部软组织剥离后；f为肿瘤周围脂肪组织的剥离范围；g为分离血管；h为血管周围组织；i为切除外生型肿瘤；j为切除内生型肿瘤

表1 经腹腔与腹膜后入路对不同位置肿瘤的肾周脂肪及邻近器官剥离原则

肿瘤位置	经腹腔入路	腹膜后入路
上极肿瘤	游离肾上腺（保留中央静脉），游离面紧贴肾上腺，局限性切除肿瘤表面肾周脂肪（防粘连）	保留Gerota筋膜背侧脂肪，维持筋膜屏障，仅剥离肾上极脂肪，避免进入胸膜腔
肾门肿瘤	优先分离十二指肠/胰尾，精准切除肿瘤表面肾周脂肪（保护门脉结构）	保留肾窦脂肪垫，预防淋巴瘘，直接暴露血管（避免腹膜返折损伤）
下极肿瘤	识别并保护结肠旁沟血管，切除肿瘤远端脂肪并保留输尿管系膜脂肪（防缺血）	避免广泛切除背侧脂肪，避开生殖血管

表1 经腹腔与腹膜后入路对不同位置肿瘤的肾周脂肪及邻近器官剥离原则

肿瘤位置	经腹腔入路	腹膜后入路
上极肿瘤	游离肾上腺（保留中央静脉），游离面紧贴肾上腺，局限性切除肿瘤表面肾周脂肪（防粘连）	保留Gerota筋膜背侧脂肪，维持筋膜屏障，仅剥离肾上极脂肪，避免进入胸膜腔
肾门肿瘤	优先分离十二指肠/胰尾，精准切除肿瘤表面肾周脂肪（保护门脉结构）	保留肾窦脂肪垫，预防淋巴瘘，直接暴露血管（避免腹膜返折损伤）
下极肿瘤	识别并保护结肠旁沟血管，切除肿瘤远端脂肪并保留输尿管系膜脂肪（防缺血）	避免广泛切除背侧脂肪，避开生殖血管

图2 复杂肾肿瘤部分切除术术中控温专利图注：a为专利简绘图；b为专利实物图；c为专利局部示意图；d为测温探头测量肾脏温度（箭头示测温探头）；e为控温专利降低肾脏温度（箭头示控温专利）；f为降温后再次测量肾脏温度（箭头示测温探头）

图3 复杂肾肿瘤部分切除术术前预判缝线长度注：a为缝线拟合曲线方程，Z=8.565+7.497·Ln（X×Y），长度、深度单位为cm；b为缝线长度过长；c为缝线长度合适（箭头示Hem-o-lok夹）

图4 复杂肾肿瘤部分切除手术创面缝合技巧示意图注：a为内外分层缝合法；b为缝合尿路及血管；c为锁边缝合法；d为早期开放+滑动夹闭法

图5 四钩定位针联合吲哚菁绿荧光协助肿瘤定位注：a为术中定位针远景；b为术中定位针近景（a，b箭头示四钩定位针）；c为分离肿瘤上部浅层实质；d为分离肿瘤上部深层实质（c，d箭头示肿瘤所在区域）

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Practical surgical techniques and future perspectives of robot-assisted complex partial nephrectomy

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Practical surgical techniques and future perspectives of robot-assisted complex partial nephrectomy