Webb Clairese M, Kamel Mohamed, Eltahawy Ehab, Faramawi Mohammed F, Shera Annashia L, Davis Rodney, Bissada Nabil, Jadhav Supriya
Department of Urology, Ain Shams University, Cairo, Egypt.
Ain Shams University, Cairo, Egypt.
Urol Ann. 2015 Apr-Jun;7(2):231-4. doi: 10.4103/0974-7796.152023.
Partial nephrectomy is a standard intervention for the treatment of small renal tumors. Our study compares the outcomes of three different partial nephrectomy methods (open, laparoscopic and robotic assisted) in obese (≥30 Kg/m(2)) patients with renal tumors.
Between 2005-2011, 66 obese patients had partial nephrectomy. Patients were divided into three groups according to intervention received: Open (n = 21), laparoscopic (n = 31) and robotic (n = 14). The outcome variables of blood loss, length of hospital stay, and complications were assessed.
Mean blood loss in the laparoscopic group (100 mls) was significantly less than open group (300 mls) and no difference between laparoscopic and robotic groups (150 mls). We observed a shorter median hospital stay in the laparoscopic group (two days) than open group (four days) and no difference between laparoscopic and robotic groups (three days). Three patients in the laparoscopic group had complications: Two grade II and one with grade III (based on Clavien-Dindo classification). Tumor location, pathology, grade, stage, patient gender, age, preoperative creatinine and postoperative creatinine were not different among the groups (P > 0.05). The mean tumor size in the laparoscopic group (2.70 cms) was significantly smaller than that of the open group (4.22 cm) (P < 0.05), but not statistically different from that of the robotic group (2.99 cm).
Our study demonstrates that in obese patients, both laparoscopic and robotic partial nephrectomy are associated with less blood loss than open partial nephrectomy. Second, the length of the hospital stay was not related to the type of utilized intervention.
肾部分切除术是治疗小肾肿瘤的标准干预措施。我们的研究比较了三种不同的肾部分切除方法（开放手术、腹腔镜手术和机器人辅助手术）在肥胖（≥30 Kg/m²）肾肿瘤患者中的治疗效果。
2005年至2011年期间，66例肥胖患者接受了肾部分切除术。根据所接受的干预措施，患者被分为三组：开放手术组（n = 21）、腹腔镜手术组（n = 31）和机器人辅助手术组（n = 14）。评估了失血量、住院时间和并发症等结果变量。
腹腔镜手术组的平均失血量（100毫升）显著少于开放手术组（300毫升），腹腔镜手术组与机器人辅助手术组之间无差异（150毫升）。我们观察到腹腔镜手术组的中位住院时间（两天）短于开放手术组（四天），腹腔镜手术组与机器人辅助手术组之间无差异（三天）。腹腔镜手术组有3例患者出现并发症：2例为Ⅱ级，1例为Ⅲ级（基于Clavien-Dindo分类）。各组之间的肿瘤位置、病理、分级、分期、患者性别、年龄、术前肌酐和术后肌酐无差异（P > 0.05）。腹腔镜手术组的平均肿瘤大小（2.70厘米）显著小于开放手术组（4.22厘米）（P < 0.05），但与机器人辅助手术组（2.99厘米）无统计学差异。
我们的研究表明，在肥胖患者中，腹腔镜肾部分切除术和机器人辅助肾部分切除术与开放肾部分切除术相比，失血量更少。其次，住院时间与所采用的干预类型无关。
