| Objective: To compare the clinical efficacy of robot assisted partial nephrectomy(RAPN)and laparoscopic partial nephrectomy(LPN)in the treatment of early renal tumors.Methods: The clinical data of patients with renal tumor who underwent partial nephrectomy by the same surgeon in our hospital from January 2018 to November 2020 were retrospectively analyzed.They were divided into LPN(n = 59)group and RAPN(n = 50)group according to the mode of operation.The clinical indexes such as operation time,intraoperative blood loss,warm ischemia time(WIT)and postoperative hospital stay between the two groups were analyzed and compared.According to the RENAL score,the two groups were divided into three groups: low risk group,medium risk group and high risk group.The operation time,estimated intraoperative blood loss and warm ischemia time of the two surgical methods were compared.According to Mayo adhesion probability score(MAP),the two groups were divided into three groups: low probability group,medium probability group and high probability group.The operation time,intraoperative blood loss and warm ischemia time of the two methods were compared.According to whether the patients were overweight or obese,the operation time and estimated intraoperative blood loss of the patients with overweight or obesity in the two groups were compared.Results:1.There was no significant difference in general data such as sex,age,glomerular filtration rate,tumor side,renal R.E.N.A.L score and MAP score,body mass index(BMI)between the two groups.The operation time and warm ischemia time of the observation group were shorter than those of the control group,while the intraoperative blood loss of the control group was higher than that of the observation group,and the difference was statistically significant(p < 0.001).There was no significant difference in the levels of creatinine and cystatin C between the two groups before and after operation.The surgical margin was negative in both groups.The postoperative drainage time and postoperative hospital stay in the observation group were significantly shorter than those in the control group(P < 0.05),but the operation cost in the observation group was significantly higher than that in the control group(P < 0.05).There was no significant difference in postoperative complications between the two groups.There was no significant difference in postoperative pathological results between the two groups.2.In the RENAL score group,there was no significant difference in operation time,intraoperative blood loss and warm ischemia time between the low risk groups(P > 0.05).In the medium and high risk groups,the operation time and warm ischemia time of the observation group were shorter than those of the control group,and the intraoperative blood loss of the observation group was less than that of the control group,and the difference was statistically significant(P < 0.05).3.According to MAP score,there was no significant difference in operation time,estimated intraoperative blood loss and warm ischemia time between RAPN group and LPN group in low probability group,but in medium probability group and high probability group,the operation time in observation group was shorter than that in control group,the estimated blood loss in observation group was less than that in control group,and the time of warm ischemia in observation group was shorter than that in control group.4.For the patients with overweight or obesity,the operation time,warm ischemia time and postoperative hospital stay in the observation group were shorter than those in the control group,and the intraoperative blood loss in the observation group was significantly less than that in the control group(P < 0.05).Conclusion:1.The new generation of robot-assisted laparoscopic partial nephrectomy is an alternative surgical technique similar to traditional laparoscopic partial nephrectomy,which is safe and effective.2.MAP score can be used to predict the presence of adhesive perirenal fat in patients undergoing partial nephrectomy(Adherent Perinephric Fat,APF),RENAL score and MAP score can well evaluate the difficulty of operation.RAPN has a significant advantage over LPN in the treatment of complex and intractable early renal tumors,such as medium-risk and high-risk.At this time,the two surgical methods are more inclined to choose RAPN3.When renal tumor patients are overweight or obese,RAPN provides better surgical results than LPN,such as shorter operation time,warm ischemia time,postoperative hospital stay,and less intraoperative blood loss. |
PDF Full Text Request