全机器人自体肾移植术在治疗复杂多发孤立肾肿瘤中的应用

doi:10.19558/j.cnki.10-1020/r.2021.02.001

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摘要 目的： 探讨机器人辅助腹腔镜行孤立肾切取联合离体肾肿瘤切除术和机器人辅助自体肾移植技术治疗复杂多发孤立肾肿瘤的安全性和可行性。方法： 纳入2019–2021年确诊的3例右侧孤立肾复杂多发肿瘤患者进行研究,其中病例1肿瘤数量为2枚,病例2和病例3肿瘤数量均为3枚,肿瘤平均大小（2.66±1.05）cm,术前平均血肌酐值（120.0±46.7）μmol/L。完善各项术前评估后,行机器人辅助腹腔镜右侧孤立肾切取、工作台肾肿瘤切除及机器人辅助自体肾移植术。结果： 手术均顺利完成,平均手术时间（485.0±17.3）min,热缺血时间（2.6±0.4）min,冷缺血时间（167.3±22.1）min,复温时间（71.3±6.7）min,术中出血量（116.7±76.4）mL。术后1 d、1个月平均血肌酐值分别为：（330.8±91.5）μmol/L,（204.1±120.3）μmol/L。术后病理诊断均为肾透明细胞癌,手术切缘阴性。1例患者术后短期接受5次血液透析治疗,无其他手术相关并发症。术后平均住院时间（15.0±7.0）d,所有患者血清肌酐值在术后1~6个月内恢复至接近术前水平。平均随访时间（11.3±8.4）个月,至末次回访时所有患者均无肿瘤局部复发及转移。结论： 机器人辅助腹腔镜孤立肾切取、离体肾肿瘤切除、机器人辅助自体肾移植技术治疗孤立肾复杂多发肿瘤安全、可行,短期疗效满意,值得进一步探索优化。

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	陈欣
	赵鉴明
	范阳
	张磊
	黄双
	袁清
	郝晓伟
	祖强
	张旭
	董隽

关键词 ：肾肿瘤, 孤立肾, 保留肾单位手术, 机器人手术, 自体肾移植, 工作台手术

Abstract：Objective： To investigate the safety and feasibility of robot-assisted laparoscopic nephrectomy combined with bench surgery and robot-assisted kidney autotransplantation to treat complex and multifocal renal tumors in solitary kidney. Methods： A total of 3 patients with complex and multifocal tumors of the right solitary kidney （2 tumors in case 1 and 3 tumors in case 2 and case 3） underwent robot-assisted laparoscopic nephrectomy, ex-vivo nephron sparing surgery and robot-assisted kidney autotransplantation during 2019-2021. The median tumor size was （2.66 ± 1.05） cm. The median preoperative serum creatinine level was （120.0 ± 46.7） μmol/L. Results： All operations were completed successfully, with a median operation time of （485.0 ± 17.3） min, warm ischemia time of （2.6 ± 0.4） min, cold ischemia time of （167.3 ± 22.1） min, rewarming time of （71.3 ± 6.7） min. The median blood loss was （116.7 ± 76.4） mL. The median serum creatine levels were （330.8 ± 91.5） μmol/L and （204.1 ± 120.3） μmol/L on the 1st and 30th day after operation, respectively. The pathology revealed the negative surgical margin of all cases of clear cell carcinoma. No other complications occurred except that case 1 received hemodialysis for 5 times in the short term after operation. The median hospital stay after operation was （15.0 ± 7.0） days, and the serum creatinine levels of all patients were close to preoperative level gradually within 1 to 6 months after surgery. The median follow-up was （11.3 ± 8.4） months. All patients survived without local recurrence or metastasis at time of last follow-up. Conclusions： This minimally invasive operation may be considered significantly as a safe and effective surgical technique to treat complex and multifocal renal tumors in solitary kidney with a satisfactory short-term effect. Larger experiences with longer follow-up are necessary for further optimization.

Key words： renal tumor solitary kidney nephron sparing surgery robotic surgery kidney autotransplantation bench surgery

收稿日期: 2021-02-05

通讯作者: 张旭,xzhang@foxmail.com;董隽,jundong@vip.126.com

引用本文:

陈欣, 赵鉴明, 范阳, 张磊, 黄双, 袁清, 郝晓伟, 祖强, 张旭, 董隽. 全机器人自体肾移植术在治疗复杂多发孤立肾肿瘤中的应用[J]. 微创泌尿外科杂志, 2021, 10(2): 73-79.
CHEN Xin, ZHAO Jianming, FAN Yang, ZHANG Lei, HUANG Shuang, YUAN Qing, HAO Xiaowei, ZU Qiang, ZHANG Xu, DONG Jun. Application of robot-assisted kidney autotransplantation in the treatment of multifocal and complex renal tumors in solitary kidney. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2021, 10(2): 73-79.

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[1] NOVICK AC, STEWART BH, STRAFFON RA.Extracorporeal renal surgery and autotransplantation: indications, techniques and results. J Urol, 1980,123(6):806-811.
[2] GORDON ZN, ANGELL J, ABAZA R.Completely intracorporeal robotic renal autotransplantation. J Urol, 2014,192(5):1516-1522.
[3] DECAESTECKER K, VAN PARYS B, VAN BESIEN J, et al.Robot-assisted Kidney Autotransplantation: A Minimally Invasive Way to Salvage Kidneys. Eur Urol Focus, 2018,4(2):198-205.
[4] ARAKI M, WADA K, MITSUI Y, et al.Robotic renal autotransplantation: first case outside of North America. Acta Med Okayama, 2017,71(4):351-355.
[5] LEE JY, ALZAHRANI T, ORDON M.Intra-corporeal robotic renal auto-transplantation. Can Urol Assoc J, 2015,9(9/10):E748-E749.
[6] 刘圣圳,董隽,罗光达,等.机器人辅助腹腔镜活体供肾切取术(附2例报告).微创泌尿外科杂志,2015,4(2):75-77.
[7] 赵鉴明,范阳,孙圣坤,等.机器人辅助腹腔镜完全腹膜外化异体肾移植术(附3例报告).微创泌尿外科杂志,2019,8(4):222-225.
[8] BRATSLAVSKY G, WM L.Long-term management of bilateral, multifocal, recurrent renal carcinoma. Nat Rev Urol, 2010,7(5):267-275.
[9] WIKLUND F, TRETLI S, CHOUEIRI TK, et al.Risk of bilateral renal cell cancer. J Clin Oncol, 2009,27(23):3737-3741.
[10] GHONEIM TP, SJOBERG DD, LOWRANCE WA, et al.Partial nephrectomy for renal tumors in solitary kidneys: postoperative renal function dynamics. World J Urol, 2015,33(12):2023-2029.
[11] CHERTOW GM, JOHANSEN KL, LEW N, et al.Vintage, nutritional status, and survival in hemodialysis patients. Kidney Int, 2000,57(3):1176-1181.
[12] FOLEY RN, HAKIM RM.Why is the mortality of dialysis patients in the United States much higher than the rest of the world? J Am Soc Nephrol, 2009,20(7):1432-1435.
[13] BHINDI B, MASON RJ, HADDAD MM, et al.Outcomes after cryoablation versus partial nephrectomy for sporadic renal tumors in a solitary kidney: a propensity score analysis. Eur Urol, 2018,73(2):254-259.
[14] HABER GP, LEE MC, CROUZET S, et al.Tumour in solitary kidney: laparoscopic partial nephrectomy vs laparoscopic cryoablation. BJU Int, 2012,109(1):118-124.
[15] SHINDER B, FARBER NJ, MAYER T, et al.Treatment of multifocal renal cell carcinoma in a solitary kidney with nivolumab. Clin Genitourin Cancer, 2017,15(1):e165-e167.
[16] CAPUTO PA, ZARGAR H, RAMIREZ D, et al.Cryoablation versus Partial Nephrectomy for Clinical T1b Renal Tumors: A Matched Group Comparative Analysis. Eur Urol, 2017,71(1):111-117.
[17] TANAGHO YS, BHAYANI SB, KIM EH, et al.Renal cryoablation versus robot-assisted partial nephrectomy: Washington University long-term experience. J Endourol, 2013,27(12):1477-1486.
[18] SCHMIT GD, THOMPSON RH, AN NK, et al.Usefulness of R.E.N.A.L. nephrometry scoring system for predicting outcomes and complications of percutaneous ablation of 751 renal tumors. J Urol, 2013,189(1):30-35.
[19] ARNOLD ML, THIEL DD, DIEHL N, et al.Comparison of baseline quality of life measures between renal cell carcinoma patients undergoing partial versus radical nephrectomy. BMC Urol, 2013,13:52.
[20] PARKER PA, SWARTZ R, FELLMAN B, et al.Comprehensive assessment of quality of Life and psychosocial adjustment in patients with renal tumors undergoing open, laparoscopic and nephron sparing surgery. J Urol, 2012,187(3):822-826.
[21] MENG MV, FREISE CE, STOLLER ML.Laparoscopic nephrectomy, ex vivo excision and autotransplantation for complex renal tumors. J Urol, 2004,172(2):461-464.
[22] BAIOCCO JA, BALL MW, PAPPAJOHN AK, et al. A comparison of outcomes for standard and multiplex partial nephrectomy in a solitary kidney: The National Cancer Institute experience. Urol Oncol, 2019,37(6):356.e1-356.e7.
[23] LEE DJ, HRUBY G, BENSON MC, et al.Renal function and oncologic outcomes in nephron sparing surgery for renal masses in solitary kidneys. World J Urol, 2011,29(3):343-348.
[24] LIU NW, KHURANA K, SUDARSHAN S, et al.Repeat partial nephrectomy on the solitary kidney: surgical, functional and oncological outcomes. J Urol, 2010,183(5):1719-1724.
[25] MOGHADAMYEGHANEH Z, HANNA MH, FAZLALIZADEH R, et al.A nationwide analysis of kidney autotransplantation. Am Surg, 2017,83(2):162-169.
[26] JANSSEN MW, LINXWEILER J, PHILIPPS I, et al.Kidney autotransplantation after nephrectomy and work bench surgery as an ultimate approach to nephron-sparing surgery. World J Surg Oncol, 2018,16(1):35.
[27] NOVICK AC, JACKSON CL, STRAFFON RA.The role of renal autotransplantation in complex urological reconstruction. J Urol, 1990,143(3):452-457.
[28] MENON M, SOOD A, BHANDARI M, et al.Robotic kidney transplantation with regional hypothermia: a step-by-step description of the Vattikuti Urology Institute-Medanta technique (IDEAL phase 2a). Eur Urol, 2014,65(5):991-1000.
[29] 范阳,董隽,祖强,等.机器人患肾切取、工作台手术联合机器人自体肾移植术在复杂肾肿瘤保留肾单位手术中的应用.中华泌尿外科杂志,2019,40(5):340-345.
[30] 王昕凝,祖强,祝强,等.机器人肾脏切取、离体肾肿瘤切除及机器人自体肾移植术治疗复杂肾肿瘤1例报告并文献复习.微创泌尿外科杂志,2018,7(3):149-153.