论文部分内容阅读
目的比较机器人辅助腹腔镜肾部分切除术(RAPN)、3D腹腔镜(3D)及传统腹腔镜(LPN)在肾肿瘤保留肾单位手术的疗效和临床使用价值。方法回顾性分析该院2012年8月-2015年4月收治的腹腔镜保留肾单位手术90例肾肿瘤患者的临床资料,其中RAPN组21例、3D组30例和LPN组39例。比较3组手术时间、热缺血时间、术中出血量、引流管引流量、术后住院时间、住院费用及术后并发症情况的差异。结果 3组手术时间分别为(129.0±13.9)、(123.9±18.7)和(137.0±22.1)min,3D组与LPN组差异有统计学意义(P<0.05),RAPN组和3D组、LPN组差异无统计学意义(P>0.05);热缺血时间分别为(18.1±5.1)、(22.2±6.5)和(25.7±5.4)min,3组间差异均有统计学意义(P<0.05);住院费用分别为(46 858.3±3 057.2)、(21 904.8±2 404.3)和(21 019.7±1 478.9)元,RAPN组与3D组、LPN组差异有统计学意义(P<0.05),3D组和LPN组差异无统计学意义(P>0.05);术中出血量、引流管引流量、术后住院时间各组间差异均无统计学意义(P>0.05);3D组1例切口延迟愈合,LPN组1例切口延迟愈合和2例肾周血肿,保守治疗后均治愈,3组手术切缘均阴性;随访1~32个月,未见复发和转移,肾功能正常。结论传统腹腔镜推广简单且费用少;3D腹腔镜的三维视野和经济性的优势有着广阔的应用前景;机器人辅助腹腔镜手术操作最灵活,将成为未来医学发展的主流术式。
Objective To compare the efficacy and clinical value of robotic-assisted laparoscopic partial nephrectomy (RAPN), 3D laparoscopy (3D) and traditional laparoscopy (LPN) in nephron-preserving kidney neoplasms. Methods The clinical data of 90 patients with renal neoplasm who underwent laparoscopic nephron surgery from August 2012 to April 2015 were retrospectively analyzed. Among them, 21 patients in RAPN group, 30 patients in 3D group and 39 patients in LPN group were retrospectively analyzed. The differences of operation time, warm ischemia time, intraoperative blood loss, drainage tube drainage, postoperative hospital stay, hospitalization costs and postoperative complications were compared. Results The operation time of the three groups were (129.0 ± 13.9), (123.9 ± 18.7) and (137.0 ± 22.1) min, respectively. There was significant difference between 3D group and LPN group (P <0.05) (P> 0.05). The durations of warm ischemia were (18.1 ± 5.1), (22.2 ± 6.5) and (25.7 ± 5.4) min, respectively. The differences among the three groups were statistically significant (46 858.3 ± 3 057.2), (21 904.8 ± 2 404.3) and (21 019.7 ± 1478.9) yuan respectively. The difference between the RAPN group and the 3D group and the LPN group was statistically significant (P <0.05). The 3D There was no significant difference between group and LPN group (P> 0.05). There was no significant difference in intraoperative blood loss, drainage of drainage tube and length of postoperative hospital stay (P> 0.05) In the LPN group, one incision delayed healing and 2 cases of perirenal hematoma were cured after conservative treatment. The margins of all the three groups were all negative. The patients were followed up for 1 to 32 months without recurrence and metastasis and normal renal function. Conclusion The traditional laparoscopy is simple and inexpensive to popularize. The 3D visual field of 3D laparoscopy and its economic advantages have broad application prospect. Robot assisted laparoscopic operation is the most flexible and will become the mainstream of future medical development.