CAJ | 학술논문

　　目的：探讨腹腔镜肾部分切除术治疗肾脏肿瘤的治疗效果及新进展。方法：2008年10月-2012年1月采用腹腔镜经后腹腔途径对52例肾肿瘤患者行LPN，40例患者阻断肾动脉主干，12例患者选择性阻断肾段动脉，肿瘤直径3.9 cm（0.8~4.9 cm），观察观察手术时间、热缺血时间、术中出血量、围术期并发症及预后。结果：52例手术均顺利完成。平均手术时间80 min（50~160 min），平均热缺血时间23 min （15~35min），术中平均出血量79 ml（10~260 ml）。2例患者术后出现迟发出血，1例保守治疗治愈，1例行介入栓塞治疗。1例术后出现漏尿，2周自行愈合。平均住院时间8.5 d（7~15 d）。术后病理示肾透明细胞癌39例，乳头状肾细胞癌6例，嫌色细胞癌2例，嗜酸细胞腺瘤2例，肾血管平滑肌脂肪瘤3例，切缘均为阴性。随访12~36个月肿瘤无复发。结论：经腹膜后途径腹腔镜肾脏部分切除术治疗T1肾肿瘤安全有效，并发症少，保留肾单位功能恢复好，值得推广应用。
　　목적：탐토복강경신부분절제술치료신장종류적치료효과급신진전。방법：2008년10월-2012년1월채용복강경경후복강도경대52례신종류환자행LPN，40례환자조단신동맥주간，12례환자선택성조단신단동맥，종류직경3.9 cm（0.8~4.9 cm），관찰관찰수술시간、열결혈시간、술중출혈량、위술기병발증급예후。결과：52례수술균순리완성。평균수술시간80 min（50~160 min），평균열결혈시간23 min （15~35min），술중평균출혈량79 ml（10~260 ml）。2례환자술후출현지발출혈，1례보수치료치유，1례행개입전새치료。1례술후출현루뇨，2주자행유합。평균주원시간8.5 d（7~15 d）。술후병리시신투명세포암39례，유두상신세포암6례，혐색세포암2례，기산세포선류2례，신혈관평활기지방류3례，절연균위음성。수방12~36개월종류무복발。결론：경복막후도경복강경신장부분절제술치료T1신종류안전유효，병발증소，보류신단위공능회복호，치득추엄응용。
Objective:To evaluate the treatment effect and the new progress of laparoscopic partial nephrectomy for kidney tumor.Method:52 cases of patients with renal tumors underwent retroperitoneal LPN from October 2008 to January 2012.Among the 52 cases,40 cases were applied with blockage to renal artery,12 cases were applied with selective blockage to renal segmentary artery. The average diameter of tumor masses was 3.9 cm(0.8~4.9 cm).The operative time,warm ischemia time,intraoperative blood loss,complications and prognosis of perioperative period were analyzed.Result:52 cases are performed successfully completed. Average operation time was 80 min(50-160 min),average warm ischemia time is 23 min(15-35 min),average intraoperative blood loss is 79 ml(10-260 ml).Complications occurred in 3 patients,postoperative hemorrhage occurred in 2 patients,1 case was cured by conservative treatment,1 underwent interventional embolization.1 case of postoperative urine leakage healed after 2 weeks.Average hospitalization time was 8.5 days(7-15 d).Among the 52 cases,39 had renal clear cell carcinoma,6 had renal papillary carcinoma,2 had oncocytoma,2 had chromophore and 3 had renal angiomyolipoma.All cases showed negative surgical margins.No tumor recurrence was found during a follow-up of 12-36 months.Conclusion:Retroperitoneoscopic partial nephrectomy for treatment of T1 stage renal tumor is worthy of promotion and application,which is safe,effective,Fewer complications and good Nephron-sparing functional recovery.