部分腎切除術於腎血管平滑肌脂肪瘤之手術成果：
機械手臂、腹腔鏡和傳統開腹式部分腎切除術的比較
謝享宸、裘坤元、賀昊中、王賢祥、陳卷書、李建儀、楊晨洸、陳正哲、洪晟鈞
台中榮民總醫院 外科部 泌尿外科
Operative outcomes of partial nephrectomy for renal angiomyolipoma : a comparision with robotic, laparoscopic and open partial nephrectomy
Hsiang-Chen Hsieh, Kun-Yuan Chiu, Hao-Chung Ho, Shian-Shiang Wang, Chuan-Shu Chen, Jian-Ri Li, Chun-Kuang Yang, Cheng-Che Chen, Sheng-Chun Hung
Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital, Taiwan
Purpose:
To present the long-term surgical result and efficacy of partial nephrectomy (RPN) in the treatment of renal angiomyolipoma (AMLs), we compared robotic (RPN), laparoscopic (LPN), and open partial nephrectomy (OPN) with perioperative outcome and renal function preservation.
Materials and Methods:
The database of a single medical center was reviewed retrospectively from October 2006 to October 2018, and patients who underwent PN for AMLs were enrolled. The patient demographics, clinical presentation, perioperative details, and postoperative outcomes were collected and analyzed.
Results:
We identified 126 (65 OPN, 23 LPN, and 38 RPN) patients who were treated with PN for renal AMLs. The average age was 48.3 (19-77, 45.23, 47.8 and 53.34 respectively) years, and 101 (80.2%) patients were female. The median size of the resected AML were 5.8, 5.21 and 4.95 cm respectively [ interquartile range (IQR) = 3.94-8.46, 3.5-6.74 and 3.75-6.14]. The median R.E.N.A.L. score were 8, 7 and 7.5. The median estimated blood loss was 300, 200 and 100 mL (IQR = 100-775, 100-350 and 50-200), and 24 (16, 4 and 4) patients required blood transfusion. Perioperative complications occurred in 30 (21, 4 and 5) patients and one of them are higher than Clavien Grade II. The median estimated glomerular filtration rate at pre-operation were 97.07 (IQR =84.83-117.98), 102.84 (IQR =82.24-114.9) and 107.64 (IQR =93.16-129.74) mL/min/1.73m2; and the latest follow-ups were 85.47 (IQR =75.18-106.42), 84.87 (IQR =81.03-96.18) and 97.04 mL/min/1.73m2, with a median of 86.6% (IQR =79.49-99.40), 87.62% (IQR =70.90-99.12) and 91.95% (IQR =80.61-100) preservation, respectively. The median follow-up period were 24 (IQR =12-54), 27 (IQR =12-58) and 27 (IQR =12-48) months. The median length of hospital stay were 7 (IQR =6-9), 6 (IQR =5-8) and 5(IQR =5-7). None of the patients had local recurrence of AML but only one patient developed complications requiring a second intervention.
Conclusion:
A long-term follow-up of PN for renal AMLs revealed good preservation of renal function with a low complication rate, less estimated blood loss, and shorter length of hospital stay in robotic group. RPN could be considered a reliable method to manage renal AMLs. However, It may be limited by tumor size and better pre-operative renal function. Nevertheless, further studies are required.