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机器人辅助部分肾切除术中使用超高分辨率CT的新型术中导航

Novel Intraoperative Navigation Using Ultra-High-Resolution CT in Robot-Assisted Partial Nephrectomy.

作者信息

Takahara Kiyoshi, Ohno Yoshiharu, Fukaya Kosuke, Matsukiyo Ryo, Nukaya Takuhisa, Takenaka Masashi, Zennami Kenji, Ichino Manabu, Fukami Naohiko, Sasaki Hitomi, Kusaka Mamoru, Toyama Hiroshi, Sumitomo Makoto, Shiroki Ryoichi

机构信息

Department of Urology, Fujita-Health University School of Medicine, Nagoya 470-1192, Japan.

Department of Radiology, Fujita-Health University School of Medicine, Nagoya 470-1192, Japan.

出版信息

Cancers (Basel). 2022 Apr 18;14(8):2047. doi: 10.3390/cancers14082047.

Abstract

To assess the perioperative and short-term functional outcomes of robot-assisted partial nephrectomy (RAPN) with intraoperative navigation using an ultra-high-resolution computed tomography (UHR-CT) scanner, we retrospectively analyzed 323 patients who underwent RAPN using an UHR-CT or area-detector CT (ADCT). Perioperative outcomes and the postoperative preservation ratio of estimated glomerular filtration rate (eGFR) were compared. After the propensity score matching, we evaluated 99 patients in each group. Although the median warm ischemia time (WIT) was less than 25 min in both groups, it was significantly shorter in the UHR-CT group than in the ADCT group (15 min vs. 17 min, = 0.032). Moreover, the estimated blood loss (EBL) was significantly lower in the UHR-CT group than in the ADCT group (33 mL vs. 50 mL, = 0.028). However, there were no significant intergroup differences in the postoperative preservation ratio of eGFR at 3 or 6 months of follow-up (ADCT 91.8% vs. UHR-CT 93.5%, = 0.195; and ADCT 91.7% vs. UHR-CT 94.0%, = 0.160, respectively). Although no differences in short-term renal function were observed in intraoperative navigation for RAPN in this propensity score-matched cohort, this study is the first to demonstrate that UHR-CT resulted in a shorter WIT and lower EBL than ADCT.

摘要

为评估使用超高分辨率计算机断层扫描(UHR-CT)扫描仪进行术中导航的机器人辅助部分肾切除术(RAPN)的围手术期和短期功能结局,我们回顾性分析了323例行UHR-CT或面积探测器CT(ADCT)引导下RAPN的患者。比较围手术期结局和术后估计肾小球滤过率(eGFR)的保留率。在倾向评分匹配后,我们对每组99例患者进行了评估。虽然两组的中位热缺血时间(WIT)均小于25分钟,但UHR-CT组明显短于ADCT组(15分钟对17分钟,P = 0.032)。此外,UHR-CT组的估计失血量(EBL)明显低于ADCT组(33 mL对50 mL,P = 0.028)。然而,在随访3个月或6个月时,两组eGFR的术后保留率无显著组间差异(ADCT组为91.8%,UHR-CT组为93.5%,P = 0.195;ADCT组为91.7%,UHR-CT组为94.0%,P = 0.160)。虽然在这个倾向评分匹配队列中,RAPN术中导航的短期肾功能没有差异,但本研究首次表明,与ADCT相比,UHR-CT导致WIT更短,EBL更低。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9db8/9032210/ecdc9409e8b2/cancers-14-02047-g001.jpg

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