经腹腔入路与腹膜后入路机器人辅助肾部分切除术治疗肾背侧肿瘤的围手术期指标比较

A comparison of peritoneal indexes between transperitoneal approach and retroperitoneal approach of robot-assisted partial nephrectomy in the treatment of dorsal renal tumors

摘要

目的 比较经腹腔入路与腹膜后入路机器人辅助肾部分切除术（RAPN）治疗肾背侧肿瘤（R.E.N.A.L.评分为P）的围手术期指标，为该类肿瘤的临床决策提供参考。方法 回顾性分析2017-2021年在郑州大学第一附属医院泌尿外科由同一术者实施RAPN的肾癌患者的临床资料，共筛选出80例肾背侧肿瘤患者完整的资料，根据手术方式分为经腹腔入路组（50例）和腹膜后入路组（30例）。比较两组患者的一般资料、病理切缘阳性率、胃肠道功能恢复时间及并发症发生情况。结果 两组患者均成功完成手术，手术切缘均为阴性且两组在热缺血时间[17（15，18）min vs.16（14，19）min，P=0.772]、手术时间[120（105，149）min vs.124（108，152）min，P=0.584]、术中估计失血量[100（50，100）mL vs.100（50，100）mL，P=0.814]和术后并发症发生率（17% vs.24%，P=0.504）等方面比较差异均无统计学意义（P＞0.05）。腹膜后入路组患者的术后胃肠道功能恢复时间显著短于经腹腔入路组[2.0（2.0，3.0）d vs.3.5（3.0，4.0）d，P＜0.001]。结论 腹膜后入路和经腹腔入路RAPN患者的围手术期结局相似，但腹膜后入路患者术后胃肠道恢复功能较快。

Abstract

Objective To compare peritoneal indexes between transperitoneal approach and retroperitioneal approach of robot-assisted partial nephrectomy (RAPN) for dorsal renal tumors via transperitoneal and retroperitoneal approaches, thereby providing reference for clinical decision-making in managing such neoplasms. Methods The clinical data of renal cancer patients undergoing RAPN performed by the same surgeon at our hospital during 2017 and 2021 were retrospectively analyzed. A total of 80 patients with complete data of dorsal renal tumors were screened and divided into two groups based on the surgical approaches: 50 cases in the transperitoneal group and 30 in the retroperitoneal group. The general information, intraoperative data, positive rate of pathological margins, recovery time of gastrointestinal functions, and incidence of complications were compared between the two groups. Results All operations were successfully completed, and the surgical margins were negative. There were no statistically significant differences in warm ischemia time [17 (15, 18) min vs. 16 (14, 19) min, P=0.772], operation time [120 (105, 149) min vs. 124 (108, 152) min, P=0.584], intraoperative blood loss [100 (50, 100) mL vs. 100 (50, 100) mL, P=0.814], and incidence of postoperative complications (17% vs. 24%, P=0.504) between the two groups (P>0.05). The postoperative recovery time of gastrointestinal functions in the retroperitoneal group was significantly shorter than that in the transperitoneal group [2.0 (2.0, 3.0) d vs. 3.5 (3.0, 4.0) d, P<0.001]. Conclusion The perioperative outcomes of patients undergoing RAPN via the retroperitoneal approach are similar to those via the transperitoneal approach. However, the retroperitoneal approach has an advantage of faster recovery of gastrointestinal functions.

关键词

肾肿瘤 / 机器人辅助肾部分切除术 / 腹膜后入路 / 经腹腔入路

Key words

renal tumor / robot-assisted partial nephrectomy / retroperitoneal approach / transperitoneal approach

参考文献

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基金资助

河南省青年科学基金项目(232300420254)

河南省科技攻关项目(242102311074)