腹腔镜与机器人辅助的囊性肾肿瘤肾部分切除术:围手术期疗效和三联疗法成就的比较

Uro Pub Date : 2024-07-21 DOI:10.3390/uro4030008
F. Prata, A. Iannuzzi, Marco Ricci, Francesca Liaci, F. Tedesco, A. Ragusa, A. Civitella, M. Pira, M. Fantozzi, Leonilde Sica, R. M. Scarpa, Rocco Papalia
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引用次数: 0

摘要

研究背景为了比较使用 Hugo™ RAS 系统的腹腔镜肾部分切除术(PN)和机器人肾部分切除术(PN)的围手术期结果和三联症发生率,一项研究于 2022 年 10 月至 2023 年 9 月间进行。研究方法22名患者在我院接受了囊性肾肿瘤微创肾部分切除术(A组:RAPN=6;B组:腹腔镜肾部分切除术=16)。三联征的定义是:手术切缘阴性、无 Clavien-Dindo ≥ 3 级并发症、eGFR 下降≤ 30%。连续变量以中位数和IQR表示,采用Mann-Whitney U检验进行比较;分类变量以频率(%)表示,采用χ2检验进行比较。在所有统计分析中,双侧 P 值小于 0.05 即为具有统计学意义。结果所有患者都成功接受了离体钳微创腹腔镜手术,无需转换或额外置管。A 组术前 eGFR 比率较低,临床肿瘤大小较高,而 B 组男性患者和双侧病变较多。不过,这些差异在统计学上并不显著(P 均大于 0.1)。在围手术期数据方面,A 组的手术时间更短(79.5 分钟对 134.5 分钟,P = 0.01),而 B 组的良性组织学趋势更高(62.5% 对 33.3%)。两组的所有其他围手术期数据具有可比性(P 均大于 0.2)。A 组和 B 组的三联成功率分别为 83.3% 和 87.5%(P = 0.80)。结论本研究强调了 RAPN 在手术时间方面优于腹腔镜手术。在接近 RAPN 学习曲线时,丰富的腹腔镜 PN 经验可能是一个关键因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Laparoscopic versus Robot-Assisted Partial Nephrectomy for Renal Tumors with Cystic Features: Comparison of Perioperative Outcomes and Trifecta Achievement
Background: To compare perioperative outcomes and trifecta rates between laparoscopic and robotic partial nephrectomies (PN) using the Hugo™ RAS System, a study was conducted between October 2022 and September 2023. Methods: Twenty-two patients underwent minimally invasive PN for cystic renal tumors at our institution (group A: RAPN = 6; group B: Laparoscopic PN = 16). The trifecta was defined as the coexistence of negative surgical margin status, no Clavien–Dindo grade ≥ 3 complications, and eGFR decline ≤ 30%. Continuous variables were presented as median and IQR and compared using the Mann–Whitney U test, while categorical variables were presented as frequencies (%) and compared using the χ2 test. For all statistical analysis, a two-sided p-value < 0.05 was considered statistically significant. Results: All patients successfully underwent off-clamp minimally invasive PN without the need for conversion or additional port placement. Group A showed a lower preoperative eGFR rate and a higher clinical tumor size, while group B displayed a higher number of male patients and bilateral lesions. However, these differences were not statistically significant (all p > 0.1). Regarding perioperative data, group A showed a lower operative time (79.5 vs. 134.5 min, p = 0.01), while group B showed a higher trend of benign histology (62.5% vs. 33.3%). All the other perioperative data were comparable between the two groups (all p > 0.2). The rate of trifecta achievement was 83.3% and 87.5% (p = 0.80) for group A and B, respectively. Conclusion: This study emphasizes the advantages of RAPN over laparoscopic procedures in terms of operative time. Extensive experience in Laparoscopic PN could be a key factor when approaching RAPN learning curve.
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