CAJ | 학술논문

目的:探讨腹腔镜下肾脏部分切除术的临床疗效.方法:肾肿瘤患者58例,包括肾癌43例,血管平滑肌脂肪瘤14例,肾素瘤1例.瘤体直径1～6cm,平均2.5±1.5cm,均采用后腹腔镜下肾肿瘤剜除术.手术过程:分离暴露肾动脉和瘤体,血管阻断夹阻断肾动脉,距离瘤体1cm用超声刀剜除完整瘤体,1-0可吸收线间断缝合创面,解除血管阻断,观察出血情况,对出血点予以缝合止血,取出肿瘤,完成手术.结果:3例因瘤体较大,或多支动脉仅夹闭1支而出血较多中转开放.手术时间65～200min,平均95±43min;术中出血20～1500mL,平均140±60mL.血管阻断时间最初10例30～45min,后48例仅为8～28min;肠道功能12～36h恢复,绝对卧床3～5d后下床活动,术后住院7～10d.随访6～48个月.术后肾图显示患侧肾脏血流良好,功能无明显异常;1例切口种植转移,1例肾门淋巴结转移,2例因术后病理报告切缘阳性而再次开放手术行根治性切除.结论:后腹腔镜下保留肾单位的肾肿瘤切除术除具有创伤小,康复快等优点外,还可以有效保留肾脏功能,适合于处理外生性生长、直径<4cm的恶性肿瘤或者稍大良性肿瘤.手术对术者腔镜下缝合打结技巧要求较高,血管控制时间一般不超过30min,需要有一定经验的医师操作.
목적:탐토복강경하신장부분절제술적림상료효.방법:신종류환자58례,포괄신암43례,혈관평활기지방류14례,신소류1례.류체직경1～6cm,평균2.5±1.5cm,균채용후복강경하신종류완제술.수술과정:분리폭로신동맥화류체,혈관조단협조단신동맥,거리류체1cm용초성도완제완정류체,1-0가흡수선간단봉합창면,해제혈관조단,관찰출혈정황,대출혈점여이봉합지혈,취출종류,완성수술.결과:3례인류체교대,혹다지동맥부협폐1지이출혈교다중전개방.수술시간65～200min,평균95±43min;술중출혈20～1500mL,평균140±60mL.혈관조단시간최초10례30～45min,후48례부위8～28min;장도공능12～36h회복,절대와상3～5d후하상활동,술후주원7～10d.수방6～48개월.술후신도현시환측신장혈류량호,공능무명현이상;1례절구충식전이,1례신문림파결전이,2례인술후병리보고절연양성이재차개방수술행근치성절제.결론:후복강경하보류신단위적신종류절제술제구유창상소,강복쾌등우점외,환가이유효보류신장공능,괄합우처리외생성생장、직경<4cm적악성종류혹자초대량성종류.수술대술자강경하봉합타결기교요구교고,혈관공제시간일반불초과30min,수요유일정경험적의사조작.
Objective:To investigate the clinical value of laparoscopic partial nephrotomy.Methods:Fifty-eight patients were treated with laparoscopic surgeries,of which 43 had renal tumors,14 had hamartoma and 1 had Renin tumor.The di-ameter of tumors ranged 1-6 cm,(2.5±1.5cm on average).Surgeries were performed through retroperitoneal route:expos-ing the tumor and renal artery;dragging the renal artery with block folder;resecting the tumor with 1cm normal renal tissue by Ultracision;compressing the wound surface with homeostasis carcasses and suturing it with line;relaxing the tube;tak-ing out the tumor tissue and finishing the surgery.Results:Three cases were turned to open surgery because of tumor of large size or multi-artery or bleeding.The surgical duration ranged from 65 to 200 min,with an average of 95±43 min.The introperative blood loss was 20 to 1500 mL approximately,with an average of 140±60mL.The artery block time was 30-45 min in the first 10 cases and 8-28 min in the other cases.Intestinal tract function recovery time and the postoperative hospi-tal stay were 12-36 hours and 10-14 days,respectively.The patients must stay in bed for 7 10 10 days.During follow up of 6 t0 48 months.patients'renal blood flow showed no obvious abnormal features,1 case had incision metastasis,1 case had renal portal lymph node metastasis,2 cases had pathological positive margin and were treated with open radical resec-tion.Conclusion:The laparoscopic enucleation of the renal tumors is a non-invasive,safe and effective therapy and can be considered as the first choice for patients with exophytic malignant tumors smaller than 4cm and benign tumors of larger size.