后腹腔镜下肾部分切除术治疗肾肿瘤的疗效评价
후복강경하신부분절제술치료신종류적료효평개
Retroperitoneal laparoscopic partial nephrectomy for the treatment of renal tumor
  • 万方数据
    中华泌尿外科杂志 중화비뇨외과잡지
    CHINESE JOURNAL OF UROLOGY
    2010年 10期 658-661 ,共4页

    邵鹏飞%殷长军%孟小鑫%吕强%李杰%居小兵%宋宁宏%秦超%徐东亮%张炜%王增军%华立新%顾民%张炜%徐正铨

    소붕비%은장군%맹소흠%려강%리걸%거소병%송저굉%진초%서동량%장위%왕증군%화립신%고민%장위%서정전

    腹腔镜%腹膜后间隙%肾部分切除术%热缺血 腹腔鏡%腹膜後間隙%腎部分切除術%熱缺血
    복강경%복막후간극%신부분절제술%열결혈
    Laparoscopes%Retroperitoneal space%Partial nephrectomy%Warm ischemia
    目的 探讨后腹腔镜下肾部分切除术治疗肾肿瘤的手术方式和临床效果. 方法 2002年6月至2009年12月对113例肾癌患者行后腹腔镜下肾部分切除术.患者平均年龄52(26～73)岁.肿瘤位于左肾51例,右肾62例.肿瘤直径平均3.7(1.2～6.3)cm.临床分期T1a 98例,T1b15例.腔镜下阻断肾动脉,以冷刀切开肾实质完整切除肿瘤.行肾楔形切除84例,肾极切除22例,半肾切除7例.腔镜下重建肾盂肾盏,2-0可吸收线间断或连续缝合关闭肾实质.开放肾动脉后取出标本.术后卧床10～14 d. 结果 113例手术均顺利完成,无中转开放及腹腔脏器损伤病例.平均手术时间85(60～125)min,平均热缺血时间24(19～43)min,术中平均出血150(50～350)ml,无术中输血患者.术后病理确诊肾透明细胞癌87例、乳头状肾细胞癌9例、嫌色细胞癌7例、肾血管周细胞瘤6例、嗜酸细胞瘤4例,肿瘤切缘均阴性.术后未出现尿漏,发生肉眼血尿2例,其中行肾切除术1例、血尿自行消失1例.随访3～41个月,未见肿瘤局部复发.结论 后腹腔镜下肾部分切除术治疗肾肿瘤安全有效,手术创伤小,有可能替代开放手术.
    목적 탐토후복강경하신부분절제술치료신종류적수술방식화림상효과. 방법 2002년6월지2009년12월대113례신암환자행후복강경하신부분절제술.환자평균년령52(26～73)세.종류위우좌신51례,우신62례.종류직경평균3.7(1.2～6.3)cm.림상분기T1a 98례,T1b15례.강경하조단신동맥,이냉도절개신실질완정절제종류.행신설형절제84례,신겁절제22례,반신절제7례.강경하중건신우신잔,2-0가흡수선간단혹련속봉합관폐신실질.개방신동맥후취출표본.술후와상10～14 d. 결과 113례수술균순리완성,무중전개방급복강장기손상병례.평균수술시간85(60～125)min,평균열결혈시간24(19～43)min,술중평균출혈150(50～350)ml,무술중수혈환자.술후병리학진신투명세포암87례、유두상신세포암9례、혐색세포암7례、신혈관주세포류6례、기산세포류4례,종류절연균음성.술후미출현뇨루,발생육안혈뇨2례,기중행신절제술1례、혈뇨자행소실1례.수방3～41개월,미견종류국부복발.결론 후복강경하신부분절제술치료신종류안전유효,수술창상소,유가능체대개방수술.
    Objective To evaluate the technique and efficacy of retroperitoneal laparoscopic partial nephrectomy. Methods From June 2002 to December 2009, 113 cases of renal tumor received retroperitoneal laparoscopic partial nephrectomy. The age ranged from 26 to 73 years. The tumor located in left side in 51 cases and right side in 62 cases with the mean diameter of 3.7 cm(1.2-6.3cm). During the procedure, the renal artery was separated and then clamped with bulldog. The renal parenchymal was incised with cold endoscissor and the tumor was totally removed. Pelvicalyceal repairing and parenchymal hemostasis were then performed. Renal defect closure was achieved with running suture or horizontal mattress suture. Results All the procedures were completed successfully.There was no open conversion. The mean operation time was 85 min(60- 125 min), the mean warm ischemic time was 24 min(19-43 min). The pathology studies revealed 87 cases of clear cell carcinoma, 9 cases of papillary renal cell carcinoma, 7 cases of chromophobe cell carcinoma, 6 cases of perivascular epithelioid renal cell tumor and 4 cases of renal oncocytoma. The surgical margin was negative in all cases. There was no complication of urine leakage. Gross hematuria occurred in 2 cases.During 3-41 months of following up, there was no recurrence. Conclusion Retroperitoneal laparo-scopic partial nephrectomy is safe and effective for the treatment of renal tumor, which becomes an alternative treatment to open procedure.
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