CAJ | 학술논문

目的：分析后腹腔镜下肾部分切除术（ retroperitoneal laparoscopic partial nephrectomy ， RLPN）治疗内生型肾肿瘤的安全性和有效性。方法回顾性分析2005年5月至2012年9月单中心收治的392例因肾肿瘤行RLPN患者的临床资料。将完全被正常肾实质包绕的肿瘤定义为内生型肾肿瘤（48例），其余为非内生型（344例）。两组患者性别、年龄、体质指数、肿瘤侧别、直径及术前估计肾小球滤过率（estimated glomerular filtration rate，eGFR）水平差异均无统计学意义（P＞0．05）。比较两组RLPN的手术时间、热缺血时间、肾血管阻断方式、集合系统修复率、术中出血量、术中并发症发生率、术中B超使用率、术后病理类型、术后住院天数、术后并发症发生率、术后eGFR数值及变化值的差异。结果内生型组较非内生型组有更普遍的术中B超使用率（95．8％和1．2％，P＜0．001）和更高的集合系统修复率（35．4％和6．1％，P＜0．001）。内生型组肾血管阻断方式为肾蒂阻断或肾动脉阻断，无分支动脉阻断或不阻断肾血管者。两组手术时间、热缺血时间、术中出血量、术中并发症发生率、病理类型、术后住院天数、术后eGFR数值及变化值比较差异均无统计学意义（ P＞0．05）。392例手术切缘均为阴性。两组并发症发生率为4．2％（2例）和2．9％（10例），组间比较差异无统计学意义（ P＞0．05）。内生型组随访33～108个月，中位时间42个月，非内生型组随访33～120个月，中位时间45个月，均未见局部复发和转移。结论有丰富后腹腔镜手术经验的医师可行RLPN治疗内生型肾肿瘤，术中B超检查有助于确定切除范围。随访结果显示，在手术安全性、有效性、肿瘤预后、保留肾功能等方面，内生型肿瘤与非内生型结果相似。
목적：분석후복강경하신부분절제술（ retroperitoneal laparoscopic partial nephrectomy ， RLPN）치료내생형신종류적안전성화유효성。방법회고성분석2005년5월지2012년9월단중심수치적392례인신종류행RLPN환자적림상자료。장완전피정상신실질포요적종류정의위내생형신종류（48례），기여위비내생형（344례）。량조환자성별、년령、체질지수、종류측별、직경급술전고계신소구려과솔（estimated glomerular filtration rate，eGFR）수평차이균무통계학의의（P＞0．05）。비교량조RLPN적수술시간、열결혈시간、신혈관조단방식、집합계통수복솔、술중출혈량、술중병발증발생솔、술중B초사용솔、술후병리류형、술후주원천수、술후병발증발생솔、술후eGFR수치급변화치적차이。결과내생형조교비내생형조유경보편적술중B초사용솔（95．8％화1．2％，P＜0．001）화경고적집합계통수복솔（35．4％화6．1％，P＜0．001）。내생형조신혈관조단방식위신체조단혹신동맥조단，무분지동맥조단혹불조단신혈관자。량조수술시간、열결혈시간、술중출혈량、술중병발증발생솔、병리류형、술후주원천수、술후eGFR수치급변화치비교차이균무통계학의의（ P＞0．05）。392례수술절연균위음성。량조병발증발생솔위4．2％（2례）화2．9％（10례），조간비교차이무통계학의의（ P＞0．05）。내생형조수방33～108개월，중위시간42개월，비내생형조수방33～120개월，중위시간45개월，균미견국부복발화전이。결론유봉부후복강경수술경험적의사가행RLPN치료내생형신종류，술중B초검사유조우학정절제범위。수방결과현시，재수술안전성、유효성、종류예후、보류신공능등방면，내생형종류여비내생형결과상사。
Objective To compare the perioperative outcomes and postoperative complications of retroperitoneal laparoscopic partial nephrectomy ( RLPN) for the treatment of endophytic renal tumors and non-endophytic tumors.Methods Three hundred and ninety-two patients who underwent RLPN for kidney neoplasms from May 2005 to September 2012 were retrospectively analyzed . They were divided into endophytic renal tumor group ( 48 cases ) and non-endophytic tumor group ( 344 cases ) .There were no significant differences in the aspects of gender , age, body mass index, tumor side, diameter, preoperative estimated glomerular filtration rate (eGFR) between the two groups.Operative time, warm ischemia time, method of renal vascular occlusion , repair rate of renal collecting system , estimated blood loss , usage of laparoscopic ultrasonography , intraoperative complications , pathological types , postoperative hospitalization days, postoperative complications and postoperative eGFR were collected and analyzed .Results Patients with endophytic tumors had significantly more usage of laparoscopic ultrasonography (95.8%versus 1.2%, P<0.001) and higher repair rate of renal collecting system (35.4%versus 6.1%, P<0.001).Clamping segmental renal artery and without clamping renal vessels were not used in dealing with renal vessels of endophytic tumors (P<0.05).There were no significant differences of operative time , warm ischemia time, estimated blood loss , intraoperative complications , pathological types , postoperative hospitalization and postoperative eGFR (P>0.05) between the 2 groups.All the patients′surgical margins were negative.The rates of postoperative complication ( Clavien gradeⅠtoⅢb) were 4.2%and 2.9%in the endophytic group and non-endophytic group , respectively ( P >0.05 ) . Median follow-up was 42 ( 33 -108 ) months in endophytic group and 45 (33 -120) months in non-endophytic group.No local recurrence or metastasis occurred in the two groups .Conclusions In experienced hands , RLPN could represent a feasible , safe and effective treatment for selected patients diagnosed with endophytic renal tumors .Laparoscopic ultrasonography is valuable on locating the tumor and defining tumor margins in RLPN of endophytic renal tumors .