CAJ | 학술논문

目的：探讨后腹腔镜下保留肾单位手术治疗巨大（最大直径≥8 cm）血管平滑肌脂肪瘤（RAML）的疗效。方法选择2005年1月—2013年11月中国人民解放军总医院泌尿外科收治的体积巨大的 RAML 患者20例。术前经影像学诊断为单侧单发 RAML，肿瘤最大直径8~22 cm，均采用肾部分切除术治疗。根据手术方法分为开放手术（ONSS）组7例和后腹腔镜手术（LNSS）组13例。术前收集患者性别、年龄、肿瘤最大直径、肿瘤体积、首诊症状等一般资料；术中收集肾脏热缺血时间、手术时长、出血量等；观察术后并发症发生情况。结果两组患者手术热缺血时间〔（24.6±5.2）min 与（24.0.±7.7）min〕、手术时长〔（184±52）min 与（154±65）min〕比较，差异无统计学意义（P ＞0.05）；LNSS 组术中出血量（307±399）ml 少于 ONSS 组（1109±879）ml，差异有统计学意义（P ＜0.05）。患者术后均卧床休息1周，8~10 d 后出院；术后病理报告均证实为 RAML，术前有疼痛主诉患者均证实存在程度不等的肿瘤内出血；术后随访1个月~8年，未发现肿瘤复发或肾残端迟发性出血。结论与 ONSS 相比，LNSS治疗巨大 RAML 能减少术中出血量，具有一定优势，为进一步临床研究提供了参考依据。
목적：탐토후복강경하보류신단위수술치료거대（최대직경≥8 cm）혈관평활기지방류（RAML）적료효。방법선택2005년1월—2013년11월중국인민해방군총의원비뇨외과수치적체적거대적 RAML 환자20례。술전경영상학진단위단측단발 RAML，종류최대직경8~22 cm，균채용신부분절제술치료。근거수술방법분위개방수술（ONSS）조7례화후복강경수술（LNSS）조13례。술전수집환자성별、년령、종류최대직경、종류체적、수진증상등일반자료；술중수집신장열결혈시간、수술시장、출혈량등；관찰술후병발증발생정황。결과량조환자수술열결혈시간〔（24.6±5.2）min 여（24.0.±7.7）min〕、수술시장〔（184±52）min 여（154±65）min〕비교，차이무통계학의의（P ＞0.05）；LNSS 조술중출혈량（307±399）ml 소우 ONSS 조（1109±879）ml，차이유통계학의의（P ＜0.05）。환자술후균와상휴식1주，8~10 d 후출원；술후병리보고균증실위 RAML，술전유동통주소환자균증실존재정도불등적종류내출혈；술후수방1개월~8년，미발현종류복발혹신잔단지발성출혈。결론여 ONSS 상비，LNSS치료거대 RAML 능감소술중출혈량，구유일정우세，위진일보림상연구제공료삼고의거。
Objective To discuss the effect of retroperitoneal laparoscopic nephrone - sparing surgery( NSS) on huge(≥8 cm) renal angiomyolipoma( RAML). Methods From january 2005 to November 2013 twenty patients with unilateral single huge RAML who had NSS operation in PLA General Hospital were divided into groups open NSS(ONSS group, n = 7)and retroperitoneal laparoscopic NSS( LNSS group,n = 13). The general information such as age,gender,tumor maximum diameter,tumor size,symptoms at their first visits were collected before operation,kidney warm ischemia time, surgery length,amount of bleeding recorded during operation,adverse reactions observed after operation. Results There was no significant difference in warm ischemia time〔(24. 6 ± 5. 2)min vs. (24. 0 ± 7. 7)min〕,surgery time〔(184 ± 52)min vs. (154 ± 65)min〕between 2 groups(P > 0. 05). The amount of bleeding was(307 ± 399)ml in LNSS group,less than in ONSS group〔(1 109 ± 879)ml〕(P < 0. 05). The patients stayed in bed for 1 week after operation and discharged on days 8 - 10. Postoperative pathological reports confirmed RAML. The patients who complained of pain before operation were conformed having varying degrees of tumor hemorrhage;all patients had 1 month - 8 year follow - ups and no tumor recurrence or delayed renal stump bleeding were found. Conclusion Compared with ONSS,LNSS treating RAML can reduce blood loss and have some advantages,which provides a reference for further clinical studies.