解剖程序化后腹腔镜肾部分切除术125例报告

目的 探讨解剖程序化后腹腔镜肾部分切除手术的安全性及可行性.方法 2004年5月至2011年1月,我院施行125例共130次解剖程序化后腹腔镜肾部分切除手术,其中男100例,女25例.年龄30~75岁,平均58岁.肿瘤位于肾上极90例,中部20例,下极20例.单侧单发肿瘤120例,双肾肿瘤5例.肿瘤直径1.0～6.0 cm,平均3.0 cm.术前按肾癌TNM肿瘤分期均为T1N0M0.结果 125例患者中,5例双肾肿瘤行分期手术.125例共130次手术,全部顺利完成,无一例中转开放,术中未出现大血管或临近脏器损伤等并发症.术后并发症出现9例,其中血尿5例,皮下气肿1例,切口延迟愈合1例,肾功能异常2例,经相关保守处理后痊愈.手术时间58～190 min,平均110 min.术中出血量90~200 ml,平均120 ml,术中均未输血.肾动脉阻断时间16~30 min,平均23 min.术后病理报告肾透明细胞癌110例,乳头状细胞癌5例,切缘均为阴性;血管平滑肌脂肪瘤15例.术后随访2~70个月,平均30个月,未发现肿瘤复发或远处转移,远期肾功能正常.结论 解剖程序化后腹腔镜肾部分切除术治疗早期局限性肾癌安全可行,值得临床推广与应用.

Anatomical and programmed retroperitoneoscopic partial nephrectomy:Report of 125 cases

Objective To investigate the safety and feasibility of anatomical and programmed retroperitoneoscopic partial nephrectomy.Methods Between May 2004 and January 2011,anatomical and programmed retroperitoneoscopic partial nephrectomy was performed in 125 patients(130 procedures) with renal tumors.There were 100 males and 25 females,age 30-75 years(mean 58).The tumors located in the upper,middle and lower pole of the kidney in 90,20 and 20 cases,respectively.One hundred and twenty patients with unilateral tumor and 5 with bilateral tumors.The tumor size was 1.0-6.0 cm,mean 3.0 cm.Before the operation,all of the cases were in stage T1N0M0.Results All the 130 procedures(125 patients,in which 5 patients with bilateral tumors underwent two operations) were successfully accomplished.No procedures had converted to open surgery,no intraoperative complications such as large blood vessels or organ damage occured.Postoperatively,hematuria occured in 5 cases,incision infection occured in 1 case,pneumoderma was observed in 1 case,and renal function decreased in 2 cases.All the postoperative complications were cured through conservative treatment.The operative time was 58-190 min,mean 110 min;the Blood loss was 90-200 ml,mean 120 ml.No patients needed blood transfusion.The average kidney ischemia time was 23 min(16-30 min).Pathology results showed 110 cases of renal clear cell carcinoma,5 cases of papillary carcinoma and 15 cases of angiomyolipoma.All renal tumors were completely removed with negative surgical margin.Patients were followed up 2 to 70 months,mean 30 months,no patients had local recurrence or metastasis.Conclusions Anatomical and programmed retroperitoneoscopic partial nephrectomy is safe and feasible,and is worthwhile to be widely applied in clinical practice.