国产机器人辅助腹腔镜下根治性肾切除术联合静脉癌栓取出术的初步临床经验

Preliminary clinical experience of domestic robot-assisted laparoscopic radical ne- phrectomy with venous tumor thrombectomy

摘要

目的：探讨国产精锋 MP1000 多孔机器人手术系统辅助腹腔镜下行根治性肾切除术联合静脉癌栓取出术的安全性与可行性。方法：回顾性分析2024年6月至2026年1月，于北京大学第三医院泌尿外科单中心接受精锋MP1000 多孔机器人手术系统辅助行该手术的 15 例肾细胞癌（renal cell carcinoma，RCC）伴静脉癌栓患者的临床资料。明确主要观察指标为手术成功率、总并发症发生率及严重并发症（Clavien-Dindo ⩾ III级）发生率；次要指标为手术时间、术中出血量、术后住院时间等。采用描述性统计学方法进行分析。结果：15例患者的手术均在机器人辅助下顺利完成，手术成功率为100％，无中转开放病例。患者中位年龄60岁，中位体重指数25.6 kg/m  ² ，中位手术时间 233.0 min，中位术中出血量 250.0 mL，5例（33.3％）接受输血，中位术后住院时间6 d。术后总并发症发生率为 6.7% (1/15) ，仅 1 例发生 Clavien-Dindo II 级淋巴漏，无III级及以上严重并发症或围手术期死亡。术后组织病理检查示肾透明细胞癌 12 例，静脉壁侵犯 8 例（53.3%）。中位随访 4.4 个月， 1 例术后 10 个月发生十二指肠转移。结论：国产精锋 MP1000 多孔机器人手术系统辅助下，腹腔镜下行根治性肾切除术联合静脉癌栓取出术在技术上是安全可行的，围手术期指标良好，但本研究的单中心、回顾性设计及小样本量限制了结论的外推性，长期肿瘤学疗效有待进一步大样本、前瞻性研究验证。

Abstract

Objective：To preliminarily investigate the safety and feasibility of domestic Jingfeng MP1000 multi-port robotic surgical system-assisted laparoscopic radical nephrectomy with venous tumor thrombectomy. Methods：Clinical data of 15 patients with renal cell carcinoma（RCC）and venous tumor thrombus who underwent Jingfeng MP1000 robot-assisted laparoscopic radical nephrectomy with venous tumor thrombectomy at the Department of Urology，Peking University Third Hospital from June 2024 to January 2026 were retrospectively analyzed.The primary outcomes were the success rate of the robotic procedure，overall complication rate，and major complication rate（Clavien-Dindo ⩾ grade III）. Secondary outcomes included operative time，estimated blood loss，and length of hospital stay.Baseline characteristics，perioperative outcomes，pathological results，and postoperative complications were col-lected and analyzed using descriptive statistical methods. Results：All the 15 procedures were successful-ly completed with robotic assistance，with no conversions to open surgery.The success rate of robotic- assisted surgery was 100％.The median patient age was 60 years，and the median body mass index was 25.6 kg/m².Ten patients had right-sided and 5 had left-sided tumors，with a median tumor diameter of 9.1 cm.According to the Mayo classification，there were 5 cases of grade 0,4 of grade I,5 of grade II ，and 1 of grade III thrombus.The median operative time was 233.0 min ，the median estimated blood loss was 250.0 mL，and 5 patients（33.3％）received blood transfusions.The median postoperative hos- pital stay was 6 days.Only one patient（6.7％）experienced a Clavien-Dindo grade II complication （lymphatic leakage），with no grade ⩾ III severe complications or perioperative mortality.Postoperative pathology revealed clear cell renal cell carcinoma in 12 cases，and venous wall invasion was confirmed in 8 patients（53.3％）.After a median follow-up of 4.4 months，one patient developed duodenal metasta-sis 10 months postoperatively. Conclusion：The domestic Jingfeng MP1000 multi-port robotic system- assisted laparoscopic radical nephrectomy with venous tumor thrombectomy is technically safe and feasi- ble，with favorable perioperative outcomes and a low complication rate.Its long-term oncological efficacy requires further validation through large-scale，prospective studies.

关键词

肾肿瘤 / 静脉癌栓 / 机器人辅助手术 / 根治性肾切除术

Key words

Kidney neoplasms / Venous tumor thrombus / Robotic-assisted surgery / Radical nephrectomy

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基金资助

国家自然科学基金(82473287)

北京大学第三医院临床队列建设项目(BYSYDL2025031)