王宇伟 1贺敏 1章立峰 1蔡嘉斌 1熊洁妮 1王金湖1
作者信息
- 1. 国家儿童健康与疾病临床医学研究中心,浙江大学医学院附属儿童医院肿瘤外科,浙江 杭州 310006
- 折叠
摘要
Abstract
Objective To investigate the efficacy of da Vinci robotic surgery in the treatment of pediatric renal tumors and summarize the experience.Methods From April 2020 to June 2023,20 children with renal tumors underwent da Vinci robot-assisted renal tumor resection at Children's Hospital,Zhejiang University School of Medicine.The cohort consisted of 9 boys and 11 girls,with 12 left tumors and 8 right tumors.The age was(7.0±4.0)years,the weight was(20.4±10.2)kg,the height was(110.1±25.2)cm,and the tumor size was(6.0±3.3)cm.Preoperative imaging evaluation confirmed that all patients had unilateral renal tumors without distant metastasis.Eleven cases of nephroblastoma and one case of renal clear cell sarcoma underwent fine needle aspiration biopsy before operation,and the tumors were confirmed to be malignant by pathology,clinically staged as stage Ⅱ or below,and treated with preoperative neoadjuvant chemo-therapy for 4 times.None of the six patients who were considered to be renal cell carcinoma before operation had lymph node metastasis or venous tumor thrombus,who were clinically staged as T1N0M0 or T2N0M0.The remaining two cases were considered to be benign tumors before operation.The operation time,intraoperative blood loss,postoperative abdominal drainage time,hospitalization cost,post-operative pathological results,subsequent treatments,and follow-up were recorded.Results All surgeries were successfully completed without conversion to open surgery or perioperative mortality,and the tumors did not rupture during the operation.The operation time was(193.3±77.8)min.The intraoperative blood loss was(21.9±28.5)mL.Radical nephrectomy was performed in 17 cases,while renal partial resection was performed in three cases.Fourteen cases required intraoperative drainage tube placement with an extubation time of(3.7±1.7)days.The hospital stay was(11.0±4.9)days,and the postoperative length of stay was(5.1±3.6)days.The hospitalization cost amounted to(71 461.9±8 165.1)Chinese yuan.No surgery-related complications occurred.Pathological examination revealed that 11 cases had nephroblastoma,six had renal cell carcinoma,two had cystic nephroma,one had renal clear cell sarcoma,and none of the malignant tu-mors had lymph node metastasis.All 11 patients with nephroblastoma received postoperative chemotherapy,and no recurrence occurred during follow-up.One patient diagnosed with renal cell carcinoma exhibited liver and lung metastases six months after operation,leading to the parents'decision to discontinue the treatment.The remaining five patients with renal cell carcinoma were monitored for a period of six months,during which no recurrence was observed.The patient with renal clear cell sarcoma underwent postoperative chemotherapy,had subsequent recurrence in the mediastinum,and is currently undergoing chemotherapy.Two cases of cystic nephroma were followed up for six months after surgery without any signs of recurrence.Conclusions In the operation of renal tumors in children,the application of da Vinci robot-assisted laparoscopic technology is accurate and flexible to complete the resection of non-metastatic and clinical stage T1 or T2 malignant renal tumors and other benign renal tumors.It is safe,effective,feasible,and worthy of further promotion in clinical practice.关键词
肾脏肿瘤/儿童/达芬奇机器人/腹腔镜Key words
renal tumor/child/da Vinci surgical system/laparoscopy
