后腹腔镜辅助小切口行肾部分切除21例疗效分析

目的:评估经后腹腔镜分离肿瘤，显露肾蒂，分离肾周脂肪后辅助小切口在部分早期肾细胞癌治疗中的临床疗效。方法:对于肿瘤直径大于4cm的周围性肿瘤及中央型、肾门旁肿瘤，采用腹腔镜下分离肾周脂肪，显露肾蒂后辅助小切口行肾部分切除，21例肾肿瘤患者术前均行CT平扫+增强。随机选取我科同期完全腹腔镜下肾部分切除16例作比较。结果:21例患者手术均顺利完成，肾蒂阻断时间为（22.90±3.72）min,平均手术时间为（189.71±12.99）min,术中出血量为（262.90±56.84）ml。瘤剜除术后病理示透明细胞癌15例，嫌色细胞癌2例，嗜酸性细胞瘤3例，肾血管平滑肌脂肪瘤1例，无1例切缘阳性。随访5-10个月，无1例术后复发。与同期16例完全腹腔肾肿瘤剜除术比较，肾蒂阻断时间、平均手术时间明显缩短（P<0.005），术中出血量无统计学差异。结论:对于中央型肿瘤、肾门旁肿瘤及大于4cm的外周性肿瘤，后腹腔镜辅助小切口肾部分切除术明显减少肾热缺血时间及手术时间，保证肿瘤切缘阴性，结合了腹腔镜手术和传统开放手术的优势，降低手术难度，值得进一步推广运用。

Analysis of 21 cases laparoscopic partial nephrectomy by retroperitoneoscopy together with small inferiorabdominal incision

Objective:To evaluate the clinical efficacy of LPN by retroperitoneoscopy together with small inferiorabdominal incision on renal cell carcinoma in early stage.Methods:Enhanced CT scan were preoperatively used on 21 cases，the diameter of tumor >4cm,and the distance to the collecting system >10mm.Sepatated perirenal fat with laparoscope，when renal pedicle appeared,small incision was applied to complete LPN，randomly selected 16 cases completely laparoscopic partial nephrectomy as control.Results:All the cases had been operated successfully，renal pedicle clamping time was (22.90±3.72)min，the mean operation time was (189.71±12.99)min，the amount of bleeding was (262.9±56.84)ml.Pathology results showed that there were 15 clear cell carcinomas，2 chromophobe cell carcinomas，3 eosinophilic cell tumors and 1 renal angiomyolipomas.The follow-up time was range from 5 to 10 months,none of them have recured.Conclusion:With regard to renal tumors which was 3-4cm，LPN by retroperitoneoscopy together with small inferiorabdominal incision was safe and effective.