980 nm半导体红激光辅助后腹腔镜下“零缺血”肾部分切除术的应用经验

目的:探讨980 nm半导体红激光辅助后腹腔镜下"零缺血"肾部分切除术的安全性和疗效。方法:回顾性分析2018年6月—2020年6月杭州市第一人民医院泌尿外科住院同意接受980 nm半导体红激光辅助"零缺血"后腹腔镜下肾部分切除术的外生型肾肿瘤患者的临床资料,其中男15例,女4例;年龄38～75岁,平均(55.4±10.7)岁;肿瘤直径2.1～4.0 cm,平均(3.22±0.75) cm;左侧8例,右侧11例;所有病例R.E.N.A.L.评分均为4～7分。19例患者均采用980 nm半导体红激光在不阻断肾动脉下行后腹腔镜下肾部分切除术。采用西班牙斗牛士公司红激光机、配套光纤(直径为550μm)以及配套光纤手件。结果:19例均顺利完成手术,均未阻断肾动脉,无中转开放手术或根治性肾全切术。手术时间104～178 min,平均(133.95±20.67) min;术中出血量50～280 mL,平均(158.42±70.65) mL;术后拔除引流管时间4～8 d,平均(5.84±1.25) d;术后住院天数8～17 d,平均(10.42±2.29) d。切缘均为阴性,无术后出血及其他严重并发...

Experience of 980 nm semiconductor red laser aided "zero ischemia" retroperitoneal laparoscopic partial nephrectomy

Objective:To investigate the safety and efficacy of 980nm semiconductor red laser aided"zero ischemia"retroperitoneal laparoscopic partial nephrectomy.Methods:A retrospective analysis was performed on the clinical data of 15males and 4females who were admitted to the urology department of Hangzhou First People's Hospital from June 2018to June 2020and agreed to receive 980nm semiconductor red laser aided"zero ischemia"retroperitoneal laparoscopic partial nephrectomy.The age was 38-75years,with an average of(55.4±10.7)years.The tumor diameter was 2.1-4.0cm,with an average of(3.22±0.75)cm.There were 8cases on the left and 11cases on the right,the R.E.N.A.L.score was 4-7points in all the cases.All the 19patients were treated with 980nm semiconductor red laser laparoscopic partial nephrectomy without blocking renal artery.Spanish matador red laser machine,matching optical fiber(550μm in diameter)and matching optical fiber hand parts were used.Results:All the 19cases were completed the operation successfully,without blocking the renal artery,transferring to open surgery or radical nephrectomy.The operative time was 104-178min,with an average of(133.95±20.67)min.Intraoperative blood loss was 50-280mL,with an average of(158.42±70.65)mL.The removal time of drainage tube was 4-8days after operation,with an average of(5.84±1.25)days.Postoperative hospitalization days ranged from 8to 17days,with an average of(10.42±2.29)days.All the surgical margins were negative,and no postoperative bleeding or other serious complications occurred.Renal function was rechecked 3months after the operation.Preoperative mean serum creatinine was(97.84±34.95)μmol/L.The mean serum creatinine at 3months after surgery was(101.68±36.32)μmol/L,suggesting no statistically significant difference(P=0.74).Postoperative pathology revealed 12cases of clear cell carcinoma and 7cases of angiomyolipoma.Long-term follow-up of 6-24months showed no tumor recurrence or metastasis.Conclusion:It is feasible and safe to perform retroperitoneal laparoscopic partial nephrectomy with 980nm semiconductor red laser without blocking renal artery.With the support of further animal experiments and large clinical sample study results,this surgical method can be further promoted in clinical practice.