Application Of Holography In Treatment Of Renal Tumor By Partial Nephrectomy

Objective: To analyze the patient data of holographic imaging in the robot-assisted laparoscopic treatment of renal tumors with nephron-sparing surgery,to evaluate the efficacy of holographic imaging technology in the treatment of nephron-sparing surgery,and to provide references for renal tumor patients to undergo nephron-saving surgery.Methods: A retrospective analysis of the case data of 97 patients with renal cell carcinoma who were diagnosed with stage T1 renal tumors before surgery in our hospital from September 2017 to December 2020 and underwent robot-assisted laparoscopic nephron-sparing surgery.All patients completed a full abdominal CT examination before the operation,and then reconstructed the two-dimensional image into a 3D model,and then fused and matched the 3D image with the intraoperative image to guide the surgeon to complete the operation.The two groups of patients were based on clinical staging Divide into T1 a and T1 b groups,analyze the perioperative data of the two groups,and further divide the two groups into the anterior approach group and the posterior approach group according to the types of internal approaches.Time group(wit≤25)and long time group(wit >25),according to the difference of R.EANL scores,they are divided into three subgroups: low complexity group(score ≤7)and moderate complexity group(score>7).The changes of renal function and tumor prognosis in the three groups were analyzed.Results: 1.Preoperative data comparison between the two groups: age,gender,BMI,tumor side,preoperative blood Scr,and preoperative total GFR in T1 b and T1 a groups were not statistically different(P>0.05).There was no significant difference between the two groups.There is comparability among them.The maximum diameter of the tumor in the T1 b group(5.63±0.73)is higher than that in the T1 a group(2.95±0.55),and the RENAL score in the T1 b group(8.0(6.25~9.0))is higher than that in the T1 a group(6.00(5.0~7.0)),There is a statistically significant difference(P<0.05).2.(1)Both groups were operated by the same doctor,and there was no intraoperative conversion to laparotomy.The operation time,WIT,intraoperative blood loss,hospital stay,renal drainage tube placement time,and perioperative period were observed in both groups.There were no significant differences in the incidence of complications,surgical costs,total hospitalization costs,postoperative blood Scr,and postoperative total GFR(P>0.05).(2)Approach subgroup: the T1 a group,the posterior approach group WIT(21(19.7~27.0))was slightly higher than the anterior approach group(19(17~23)),the difference was statistically significant(P<0.05),the intraoperative blood loss in the T1 b group was anterior approach group(200(50~600))It was significantly higher than the posterior entry group(50(35-100)),and the gap was statistically significant(P<0.05).(3)WIT subgroup: the operation time of the long-term group(206(146-238))in the T1 a group was higher than that of the short-term group(145(125-180))and the intraoperative blood loss in the long-term group(175(50-300))Higher than the short-term group(50(50-100)),long-term group postoperative complications(6(37.5%))higher than the short-term group(6(12.2%)),long-term group postoperative GFR The decline rate(20(15-24))in the short-term group(5(3.2-10)))was significantly higher in the short-term group,and the difference was statistically significant(P<0.05).The operation time of the long-term group in the T1 b group(178.15±30.0)was higher than that of the short-term group(156.3±34.34),and the intraoperative blood loss(90(50-200))in the long-term group was higher than that in the short-term group(50(35-100))),the postoperative GFR reduction rate in the long-term group(20(16-25))was significantly higher in the short-term group(6(4-14))and the short-term group was significantly higher(P<0.05)(4)RENAL subgroup: There was no significant difference in perioperative indicators between the low difficulty group and the medium difficulty group in the T1 a group(P>0.05),and the intraoperative blood loss(100(50 ~ 400))in the medium difficulty group in the T1 b group was high In the low-degree difficulty group(50(27.5-170)),the long-term hospitalization group(15.79±13.69)was higher than the short-term group(12.88±0.83),the difference was statistically significant(P<0.05).Conclusion: 1.RAPN under holographic imaging has the same safety as T1 a patients in the treatment of T1 b patients 2.The effect of RAPN via retroperitoneal approach and via intraperitoneal approach under holographic images is equivalent 3.Intraoperative warm ischemia time should be controlled within 25 minutes to better protect postoperative renal function 4.RAPN under holographic images still has good curative effect and prognosis when dealing with complex renal tumors with high R.E.N.A.L.scores...