Tsai Sheng-Han, Lai Yi-Chen, Wu Nai-Yuan, Chung Hsiao-Jen
Department of Urology, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC.
Department of Urology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei, 11217, Taiwan, ROC.
Int Urol Nephrol. 2017 Feb;49(2):225-232. doi: 10.1007/s11255-016-1463-0. Epub 2016 Nov 22.
Relative few studies reported the changes in split renal function using renal scintigraphy for robot-assisted partial nephrectomy (RaPN) for renal tumor >4 cm. This study aimed at demonstrating that RaPN is safe for renal tumor >4 cm without damaging the renal function of ipsilateral and contralateral kidney.
Patients who underwent RaPN for single renal tumor from December 2009 to December 2013 were identified from a prospectively collected database. We compared demographic, perioperative, and postoperative outcomes between patients with renal tumor >4 cm (case group) and patients with renal tumor ≦4 cm (control group). Renal function was assessed by serum creatinine, estimated glomerular filtration rate, and effective renal plasma flow (ERPF).
One hundred and three consecutive patients (45 in case group and 58 in control group) were identified. Case group had significantly longer operative time (P = 0.011), longer warm ischemia time (P < 0.001), and more estimated blood loss (P = 0.010) than control group. Only one patient in the case group had conversion surgery. There was no significant difference regarding hospital stay, blood transfusion, complications rate, and positive surgical margin. The changes in ipsilateral ERPF and contralateral ERPF were not significantly different between groups (ipsilateral kidney: -10.5 vs. -12.5%, P = 0.989; contralateral kidney: -3.6 vs. -5.2%, P = 0.611).
RaPN is a safe and feasible modality of nephron-sparing surgery for renal tumor >4 cm, as it is for renal tumor ≦4 cm.
相对较少的研究报道了使用肾闪烁扫描术评估机器人辅助肾部分切除术（RaPN）治疗直径>4 cm肾肿瘤时患侧肾功能的变化情况。本研究旨在证明，对于直径>4 cm的肾肿瘤，行RaPN是安全的，不会损害患侧和对侧肾脏的肾功能。
从一个前瞻性收集的数据库中确定2009年12月至2013年12月期间因单发性肾肿瘤接受RaPN的患者。我们比较了肾肿瘤直径>4 cm的患者（病例组）和肾肿瘤直径≤4 cm的患者（对照组）的人口统计学、围手术期和术后结果。通过血清肌酐、估算肾小球滤过率和有效肾血浆流量（ERPF）评估肾功能。
共确定了103例连续患者（病例组45例，对照组58例）。病例组的手术时间明显更长（P = 0.011），热缺血时间更长（P < 0.001），估计失血量更多（P = 0.010）。病例组仅1例患者转为开放手术。两组在住院时间、输血、并发症发生率和手术切缘阳性率方面无显著差异。两组间患侧ERPF和对侧ERPF的变化无显著差异（患侧肾脏：-10.5% 对 -12.5%，P = 0.989；对侧肾脏：-3.6% 对 -5.2%，P = 0.611）。
对于直径>4 cm的肾肿瘤，RaPN是一种安全可行的保肾手术方式，对直径≤4 cm的肾肿瘤亦是如此。
