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Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
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在机器人辅助部分切除术中,使用虚拟三维图像辅助进行最小层切除的功能结果.

Shuji Isotani1, Tomoki Kimura1, Taiki Ogasa1

  • 1Department of Urology, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan.

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概括

机器人辅助部分切除术 (RAPN) 使用最小层切除 (MLR) 方法保护功能,并为局部癌提供瘤安全性. 这种技术显示出良好的中期结果,发现了功能下降的预测因素.

关键词:
最小层切除 (MLR) 方法.机器人辅助部分切除术 (RAPN)三维虚拟部分切除术 (3DvPN)

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科学领域:

  • 泌尿器科 泌尿器科 泌尿器科 泌尿器科
  • 手术瘤学手术瘤学
  • 腎臟病學 (nephrology) 是一種醫學專業.

背景情况:

  • 机器人辅助部分切除术 (RAPN) 是局部细胞癌 (RCC) 的标准,重点是功能维护.
  • 以3D虚拟部分切除 (3DvPN) 规划为指导的最小层切除 (MLR) 方法旨在平衡瘤安全性和对细胞的保存.
  • 这项研究评估了RAPN与MLR的功能和瘤结果,并确定了功能衰退的预测因素.

研究的目的:

  • 在3DvPN规划的指导下,使用MLR技术评估RAPN的功能和瘤结果.
  • 确定与RAPN与MLR后功能衰退相关的预测因素.
  • 评估MLR在平衡瘤安全和对酶体保存方面的有效性.

主要方法:

  • 在2012年至2022年期间接受RAPN的237名患者的回顾性分析,至少进行36个月的随访.
  • 3DvPN规划指导MLR;根据指示使用了MLR和非MLR技术.
  • 主要终点:36个月估计的淋巴细胞过率 (eGFR) 保存;次要终点:术后结果,急性损伤 (AKI),边缘干扰和复发.

主要成果:

  • 患者的中位年龄为60岁,瘤大小为29毫米,热性缺血时间 (WIT) 为21分钟; 62.8%的患者实现了选择性或超选择性紧.
  • 术后AKI发生在25.0%的患者中;在3年内EGFR保存的中位数为84.4%,其中28.5%经历了≥10%的下降.
  • 短期eGFR下降的独立预测因素包括BMI>25 kg/m2,AKI和WIT>25分钟;长期下降与瘤大小>30毫米和WIT>25分钟有关. 边际参与率为1.7%,复发率为3.8%.

结论:

  • 根据3DvPN指导,RAPN与MLR显示了有利的外科手术结果,可接受的瘤安全性,以及高达36个月的良好中期功能保存.
  • 这种方法提供了一种可重复的策略,可以最大限度地保持对酶体的保存,同时保持负的外科手术边缘.
  • 需要进一步的前性多中心研究和更长的随访,以确认长期耐用性,并确定MLR在常规实践中的作用.