射频消融辅助下不阻断肾蒂血管行腹腔镜肾部分切除术

目的 探讨射频消融辅助下不阻断肾蒂血管行腹腔镜肾部分切除术( RF-LCPN)的可行性及临床疗效。方法 2009年1月至2010年6月采用RF-LCPN治疗肾肿瘤14例，共14个肿瘤。肿瘤直径平均3.1(2.2 ～4.0) cm。临床分期均为T1aN0M0。术前常规查血肌酐(SCr)（87±36）μmol/L、患肾肾小球滤过率(GFR) (45±11) ml/min。结果 14例患者手术均成功，平均手术时间( 152±46) min，平均出血量(89±52)rnl，术中快速病理提示标本切缘均阴性。术后出现短暂漏尿1例，通过放置输尿管双J管及留置导尿后治愈。术后平均住院(5±2)d。术后SCr(90±38)μmoI/L，患肾GFR(41±12) ml/min，与术前比较差异无统计学意义(P＞0.05)。14例平均随访17(6 ～25)个月。无局部复发或远处转移病例。结论 RF-LCPN安全有效，并能减少肾脏热缺血时间，但远期疗效尚需进一步观察后明确。

Radiofrequency ablation-assisted laparoscopic partial nephrectomy without renal hilar vessel clamping: a report of 14 cases

ObjectiveTo evaluate the clinical feasibility of radiofrequency ablation-assisted laparoscopic partial nephrectomy(RF-LCPN) without renal hilar vessel clamping. MethodsFrom January 2009 to June 2010, 14 cases with renal tumors were treated with RF-LCPN. The mean tumor size was 3. 1 cm (range: 2. 2-4. 0 cm). All cases were staged at T1a N0M0. The preoperative serum creatinine (SCr)was (87 ± 36) μmol/L and glomerular filtration rate (GFR) (45 ± 11 ) ml/min. ResultsRF-LCPN was technically successful in all patients (14 tumors). The mean operative time was (152 ±4.6) min and the mean blood loss (89 ± 52) ml. All tumor margins were negative. One patient with a brief period of urine leakage from lower pole calix was managed successfully by ureteral stenting and Foley catheter drainage of bladder. The postoperative hospital stay was (5 ± 2 ) days. The postoperative SCr was (90 ± 38 ) μmol/L and GFR (41 ± 12) ml/min. There was no statistic post-operative change of SCr and GFR (P ＞ 0. 05). All patients completed a minimum follow-up of 6 months (mean: 17 months, range: 6 -25 months).No evidence of local or port-site recurrence or metastasis was found. ConclusionAs an accurate and effective intervention with a relatively low incidence of complications, RF-LCPN may eliminate renal warm ischemia. But its long-term efficacy remains to be further studied.