腹腔镜肾部分切除术治疗肾肿瘤患者临床应用价值

目的：观察行腹腔镜肾部分切除术（LPN）治疗肾肿瘤患者临床应用效果。方法2008年1月至2011年12月采用腹腔镜经腹腔途径对60例肾肿瘤患者行LPN。病理检查结果为局限性肾透明细胞癌35例,乳头状肾细胞癌1例,嫌色细胞癌1例,肾血管平滑肌脂肪瘤23例。肿瘤直径2.0-5.0cm,平均直径3.6cm。左侧36例、右侧24例。观察手术时间、术中出血量、住院天数,并发症及手术效果。结果60例手术均顺利完成。平均手术时间50-130min,平均时间75min。52例患者平均血管阻断时间15-45min,平均时间24min,术中平均出血量50-350m1,平均出血量100ml。1例术后出现迟发出血,予以保守治疗,1例术后出现漏尿。住院时间8-17d,平均住院时间9.5d。随访4-36个月肿瘤无复发。结论 LPN安全、有效、出血少、恢复快。     

后腹腔镜肾部分切除术治疗肾肿瘤的临床观察

目的分析临床肾肿瘤患者行后腹腔镜肾部分切除术的效果。方法调查对象从我院2010年2月~2014年5月接收肾肿瘤患者中抽选(共60例),将其分成不同临床处理组,即:对照组(开放肾部分切除术处理)、研究组(后腹腔镜肾部分切除术处理),预后对疾病效果进行评定。结果研究组患者预后并发症发生率为3.3%,和对照组的20.0%相比较低,两者有区别(P<0.05)。并且两组肾肿瘤患者手术时间、出血量、住院时间等围术期指标有区别(P<0.05)。结论临床针对肾肿瘤患者行后腹腔镜肾部分切除术作用突出,可加快康复进度,减少并发症,值得借鉴。     

3D后腹腔镜肾部分切除术治疗T_(1b)期肾癌的临床研究

目的探讨临床T1b期肾癌选择3D后腹腔镜下肾部分切除术(3D-RLPN)的安全性与可行性。方法回顾性分析2014年6月至2015年10月徐州医科大学附属淮安医院15例临床分期为T1bN0M0肾癌并行3D-RLPN患者的临床资料,其中男性10例,女性5例,平均年龄(54.8±4.6)岁,肿瘤平均直径(5.2±1.6)cm,RENAL评分低复杂2例,中复杂8例,高复杂5例。结果 15例成功完成3D-RLPN,无中转开放或术中更换2D腹腔镜系统情况发生,围手术期无严重并发症。平均手术时间(146.9±16.6)min;平均热缺血时间(26.2±6.4)min;平均术中出血量(162.6±17.6)ml;平均术后拔出引流管时间(2.86±0.58)d;平均术后住院时间(9.6±1.6)d。术后共4例患者出现并发症,其中包括2例患者出现短暂血肌酐升高(Clavien分级Ⅰ级),1例患者出现高热39.8℃(Clavien分级Ⅰ级),1例患者术后输血(Clavien分级Ⅱ级)。标本切缘和基底肉眼及镜下观察均阴性;术后3个月复查平均血肌酐(72.9±2.8)μmol/L,与术前比较差异无统计学意义(P>0.05);术后患者随访3~20个月,均未见肿瘤复发与转移。结论 3D后腹腔镜成像系统在术中空间定位及深度感觉上有明显优势,其治疗临床T1b期肾癌安全可靠,疗效良好,术后对肾功能影响小,短期随访效果满意。     

全息影像技术在机器人辅助腹腔镜下肾部分切除术治疗肾门部肿瘤中的应用

目的评价全息影像技术引导机器人辅助腹腔镜下肾部分切除术(RAPN)治疗肾门部肿瘤的可行性与有效性。方法回顾性分析该院2019年6月-2019年10月收治的11例肾门部肿瘤患者的临床资料。其中,男3例,女8例;左侧4例,右侧7例;患者年龄32~75岁,平均62.6岁,体质指数19.45~28.12 kg/m^2,平均23.75 kg/m^2,肿瘤直径1.1~6.7 cm,平均2.76 cm,R.E.N.A.L.评分8~12分,平均10.7分,患肾肾小球滤过率(GFR)22~51 mL/min,平均35 mL/min。患者术前行全腹部增强CT,利用CT数据进行全息影像重建。术中应用该技术结合达芬奇机器人辅助系统,精准分离、剜除肿瘤,并记录手术持续时间、出血量、肾脏热缺血时间、有无并发症及切缘阳性率等。结果根据全息影像引导,11例患者均顺利剜除肿瘤,完成手术,无中转开放。手术时间60~130 min,平均90 min。术中出血量50~180 mL,平均100 mL,热缺血时间18~25 min,平均21 min,无术后发热、继发出血或漏尿等并发症。术后病理诊断肾透明细胞癌9例(FuhrmanⅠ和Ⅱ级),乳头状细胞癌1例,血管平滑肌脂肪瘤1例,无切缘阳性病例。术后随访3~7个月,平均4.3个月,患肾GFR 18~43 mL/min,平均31 mL/min。术后3个月复查肾脏CT平扫及增强,全部患者未出现复发。结论全息影像技术引导RAPN治疗肾门部肿瘤,围手术期并发症少,安全有效。     

腹腔镜下肾部分切除治疗肾肿瘤的临床疗效分析

目的:探讨腹腔镜下肾部分切除治疗肾肿瘤的临床疗效。方法:随机抽取2015年1月至2016年1月本院收治的120例肾肿瘤患者,随机分为研究组和对照组,各60例。其中对照组的60例患者给予开放性肾部分切除术,研究组的60例患者给予腹腔镜下肾部分切除术。观察两组患者的手术情况及术后恢复情况。结果:两组患者的平均出血量、手术切口、引流管放置时间、手术时间、住院时间经对比分析,P <0.05,差异具有统计学意义。结论:腹腔镜下肾部分切除术的治疗效果好,创伤小,恢复快。     

腹腔镜肾部分切除术与根治性切除术治疗T2a期肾癌的效果比较

目的 比较腹腔镜肾部分切除术与根治性切除术对T2a期肾癌的效果及随访结局。方法 选取2018年3月至2021年3月许昌市中心医院收治的T2a期肾癌患者60例为研究对象。依据手术方式不同分为腹腔镜肾部分切除术(LPN)组与腹腔镜根治性肾切除术(LRN)组,每组30例。比较两组手术前后近期肾相关指标[血红蛋白(HGB)、血肌酐(Scr)水平及肾小球滤过率(eGFR)]、炎症因子[肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)及白细胞介素-6(IL-6)]、体液免疫[免疫球蛋白G(IgG)、免疫球蛋白M(IgM)、免疫球蛋白A(IgA)]、细胞免疫(CD4⁺、CD8⁺及CD4⁺/CD8⁺)水平及生存情况。结果 术前,两组HGB、Scr水平及eGFR比较,差异未见统计学意义(P>0.05);术后1 d,两组HGB水平比较,差异未见统计学意义(P>0.05),LPN组Scr水平明显低于LRN组,eGFR水平明显高于LRN组,差异有统计学意义(P<0.05)。术前,两组TNF-α、CR...     

9例孤立肾肿瘤腹腔镜肾部分切除术患者的护理

回顾分析9例孤立肾肿瘤腹腔镜肾部分切除术患者的护理经验.术前加强心理支持,监测尿量评估肾功能.术后严密监测和及时调整血压、尿量,加强活动护理、饮食指导,防止各种并发症.经过有效的护理,本组术后恢复良好,伤口引流管在3~5 d内拔除,无发生严重并发症.随访1~15个月,无明显血肿及肿瘤复发,肾功能正常.认为在术前、术后重点做好孤立肾功能保护和预防出血这2方面的护理,是患者顺利康复和保持孤立肾功能长期良好的保障.     

65例肾肿瘤病人行腹腔镜下肾部分切除术的护理

对65例肾肿瘤病人实施腹腔镜下肾部分切除术,术前做好充分准备及心理护理,术后加强生命体征监测,做好各种管道护理。防止并发症的发生,结果65例肾肿瘤病人均顺利通过麻醉、手术,术后恢复良好。     

后腹腔镜肾部分切除术治疗小肾癌42例报告

目的总结后腹腔镜技术对小肾癌(直径≤4 cm)行肾部分切除术的经验。方法 42例肾占位患者,肿瘤直径1.2~4.0 cm,经后腹腔途径施术,术后病理为40例肾脏透明细胞癌,2例乳头状肾癌。结果 41例手术均顺利完成,1例中转开放手术,手术时间60~150 min,平均105 min。肾动脉阻断时间15~37 min,平均24 min。术中出血量20~150 ml,平均60 ml。术后恢复顺利,住院7~10 d,平均8 d,随访3~24个月无肿瘤复发。结论后腹腔镜下肾部分切除术治疗小肾癌安全有效,可以作为小肾癌的首选治疗方法。     

小肾癌手助腹腔镜和开放肾部分切除术的临床效果比较

目的比较小肾癌手助腹腔镜和开放肾部分切除术的临床效果。方法回顾分析30例行手助腹腔镜肾部分切除术和20例行开放肾部分切除术患者的病例资料,比较两种手术方法的失血量、手术时间、热缺血时间、切缘阳性率、患者住院时间、并发症及手术效果的差异。结果手助腹腔镜组和开放手术组平均肿瘤大小分别为（2．58±0．50）和（2．62±0．60）cm（P〉0．05）,平均出血量分别为（120．2±38．9）和（353．6±89．6）ml（P〈0．01）,平均手术时间分别为（158．2±27．6）和（196．2±39．6）min（P〈0．05）,平均热缺血时间分别为（26．1±3．2）和（35．2±2．8）min（P〈0．05）,平均住院时间分别为（7．8±2．0）和（12．3±3．0）d（P〈0．01）,两组的切缘阳性率、并发症发生率均无差异。随访3～28个月,两组均未出现局部复发。结论手助腹腔镜肾部分切除术较开放肾部分切除术手术时间短,出血少,住院时间短,且不增加热缺血时间,手术效果相当。     

Analysis of trifecta outcomes in a single center with robot-assisted partial nephrectomy for T1b renal tumors

Introduction

This study was performed to investigate the preoperative factors associated with difficulty achieving trifecta in robot-assisted partial nephrectomy for clinical T1b renal cell carcinoma.

Methods

Among 187 patients who underwent robot-assisted partial nephrectomy at our hospital from March 2012 to February 2022, we retrospectively examined 30 patients with unilateral single clinical T1b renal cell carcinoma with at least 6 months of postoperative follow-up, excluding patients with hereditary disease. The following factors were examined in detail: patient-related factors, perioperative factors, surgical techniques, tumor factors, and R.E.N.A.L. nephrometry scores. We examined the preoperative factors associated with difficulty achieving trifecta. A positive surgical margin was pathologically defined as the presence of tumor cells at the margin of the resected specimen or visually defined as intraoperative tumor incision or pseudocapsular damage.

Results

Of the 30 patients in this study, 12 achieved trifecta and 18 did not. The reasons for not achieving trifecta were a warm ischemia time of >25 min (66.7%), positive surgical margin (23.3%), and Clavien–Dindo grade ≥3 complications (13.3%) (with overlapping factors). No patients had a pathologically positive surgical margin. Visually positive surgical margins were confirmed by the surgical records and surgical videos. Achieving trifecta was challenging in the multivariate analysis when the “L” component of the R.E.N.A.L. nephrometry score was ≥2 points.

Conclusion

A preoperative “L” component of ≥2 points in the R.E.N.A.L. nephrometry score was associated with difficulty achieving trifecta.     

机器人辅助腹腔镜肾部分切除患者术后舒适卧位探讨

目的探讨机器人辅助腹腔镜肾部分切除手术后患者最舒适的卧位。方法抽取80例行机器人腹腔镜肾部分切除手术后的患者,随机分为观察组和对照组,观察组患者手术后经医生允许采用早期舒适卧位,即颈部垫软枕、腰部垫20cm×20cm硬枕仰卧位;对照组患者术后按传统方法采用平卧位。术后前2d进行观察比较,找出患者最舒适卧位。结果观察组患者睡眠、情绪稳定及腰肌酸痛情况明显优于对照组（P〈0．05）。结论机器人辅助腹腔镜肾部分切除手术后卧床期间采取颈部垫软枕、腰部垫20cm×20cm硬枕的仰卧位方式,患者最舒适。     

Concept of a fiber guidance instrument for laser-assisted laparoscopic partial nephrectomy

Objective

New developments in laser-assisted laparoscopic partial nephrectomy (LLPN) have created a demand for surgical tools which are compatible with laparoscopic equipment to ensure that laser-assisted technique is safer and reproducible. A concept was developed for a novel laser fiber guidance instrument based upon observations made during minimally invasive LLPN with a modified, commercially available ENT laser guidance instrument.

Patients and methods

Ten patients underwent laser-assisted laparoscopic/retroperitoneoscopic partial nephrectomy by means of fiber-assisted light application of 1318 nm using a surgical diode laser (Eraser; Rolle&Rolle, Austria). Observations made during the laparoscopic procedure were analyzed with a view to developing a novel laser fiber guidance instrument taking into account intraoperative laser-related requirements.

Results

All laparoscopic procedures were completed without any changeovers to open surgery. Tumor locations (kidney: 5 left/5 right) were central (1/10), upper pole (2/10), lower pole (2/10) and middle kidney parenchyma (5/10). The mean operation time and blood loss were comparable to standard techniques. All patients showed a favorable outcome with uneventful postoperative convalescence. A concept for a new instrument was developed taking into consideration the drawbacks associated with the clinical handling of the used modified ENT laser guidance instrument and ensuring that the new instrument is simple, cheap and easy to produce as well as easy to handle.

Conclusion

The in vivo observational study presented here shows that the 1318 nm emitting diode laser is a promising device for LLPN. Laser-based treatment facilitates for both good coagulation as well as cutting effects. The observations made resulted in a concept for an improved instrument. It is therefore conceivable that in the future there will be a wider use of LLPN for selective and precise laser resection of tumors with almost bloodless operation field and adequate fiber manipulation.     

QuillTM缝线在腹腔镜肾部分切除术中的应用

目的探讨QuillTM缝线在腹腔镜肾部分切除术应用中的安全性及有效性。方法回顾性分析2015年6月至2020年1月西藏自治区人民医院泌尿外科完成的腹腔镜肾部分切除术38例,根据应用缝合线的不同分为普通缝线组和QuillTM缝线组。普通缝线组20例,均采用2-0单乔线缝合内层,线尾固定Hem-o-lok夹,1-0可吸收线缝合肾缺损,出肾被膜每针均固定1个Hem-o-lok夹;QuillTM缝线组18例,均采用2-0倒刺线缝合内层,1-0倒刺线缝合肾缺损处,采用连续缝合,最后肾被膜出针处固定1个Hem-o-lok夹。比较2组的手术时间、热缺血时间、术中出血量、术后并发症情况。结果38例患者手术均顺利完成,无中转开放或肾切除病例,2组的手术时间、术中出血量比较差异无统计学意义(P>0.05)。普通缝线组平均热缺血时间[(25±5)min]大于QuillTM缝线组[(15±4)min],差异具有统计学意义(t=3.32,P=0.002)。2组均无术中并发症,普通缝线组1例因术后出血行选择性肾动脉栓塞,1例因漏尿留置D-J管。QuillTM缝线组术后无出血、漏尿等并发症。结论倒刺缝合在腹腔镜肾部分切除术中应用安全、有效,可减少平均热缺血时间及术后并发症的发生率。     

腹腔镜与开放保留肾单位手术干预肾脏占位性疾病疗效及生存质量研究

目的：评价腹腔镜与开放保留肾单位手术在干预肾脏占位性疾病的疗效及远期生存质量方面的作用。方法纳入2009年6月至2011年6月在我院行肾部分切除术的肾脏占位性疾病患者65例,其中试验组（腹腔镜肾部分切除术组）35例和对照组（开放肾部分切除术组）30例。比较两组手术时间、术中肾蒂阻断时间、失血量、术后3d内血肌酐水平、胃肠功能恢复时间、术后并发症、住院时间等各项指标及远期生存质量量表SF-36评分。结果65例手术均顺利完成。腹腔镜组较对照组手术出血量少[（50.6±20.3）ml vs.（308.6±95.6）ml],胃肠功能恢复快[（2.7±0.8）d vs.（3.8±1.3）d],住院时间短[（13.2±3.1）d vs.（16.4±4.3）d];手术时间[（122.1±55.6）min vs.（96.2±50.5）min]和术中肾蒂阻断时间[（28.3±2.5）min vs.（18.3±8.2）min]较长,差异均有统计学意义（P＜0.05）。术后2年远期生存质量量表评分较对照组在情感职能（50.4±20.2 vs.42.7±11.3）、活力（56.3±23.2 vs.40.2±10.9）等项目上有一定提高（P＜0.05）。结论本研究显示腹腔镜手术与开放手术相比具有出血少,恢复快,住院时间短等优势。但是手术时间和术中肾脏血供阻断时间较长。     

Laparoendoscopic single-site nephrectomy for hemodialysis patients with dialysis-related renal tumors

Purpose: The purpose of this study is to assess the efficacy of laparoendoscopic single-site (LESS) nephrectomy in hemodialysis patients, we compared outcomes between LESS nephrectomy and conventional laparoendoscopic nephrectomy in hemodialysis patients with dialysis-related renal tumors.

Material and methods: A total of 16 hemodialysis patients who underwent LESS nephrectomy (LESS-N; n?=?8) or conventional laparoendoscopic nephrectomy (C-N; n?=?8) between November 2003 and July 2012 were retrospectively evaluated. Outcomes were compared between the two groups.

Results: Patient and tumor characteristics were similar between the LESS-N and C-N groups. The mean operative duration was longer in the LESS-N than in the C-N group (231.0?±?26.7?min versus 188.6?±?36.4?min; p?=?.025). The mean estimated blood loss was lower in the LESS-N compared with the C-N group (26.4?±?14.4?ml versus 65.6?±?45.2?ml; p?=?.047). Postoperative complications were observed in three cases, comprising one case of retroperitoneal hematoma in the LESS-N group and one case each of peritoneal hematoma and retroperitoneal abscess in the C-N group. Surgical scarring was minimal in the LESS-N group.

Conclusions: Although there is a little extension of the operating time, LESS nephrectomy in hemodialysis patients is a feasible procedure compared with the conventional method.     

Self-retaining barbed suture reduces warm ischemia time during laparoscopic partial nephrectomy

Objective: To evaluate the efficacy and safety of self-retaining barbed suture in renorrhaphy during laparoscopic partial nephrectomy by comparing surgical outcomes in a prospective randomized manner.

Material and methods: From July 2014 to July 2015, a total of 60 patients with T1 renal tumor were randomized into two equal groups: self-retaining barbed suture (SRBS) and conventional absorbable polyglactin suture (non-SRBS group). All patients were treated by retroperitoneal laparoscopic partial nephrectomy. One surgeon with high volume experience performed all procedures. The patient demographics and perioperative outcomes were compared.

Results: The patient demographics and tumor characteristics were comparable. The mean tumor size and R.E.N.A.L. scores were comparable between the two groups. LPN was successfully accomplished in all patients without open conversion. The warm ischemia and renorrhaphy times were significantly shorter in the SRBS group (18.8?±?8.2 vs. 22.9?±?7.3?min, P?=?.04; 10.4?±?3.7 vs. 13.8?±?5.6?min, P?=?.01). The minor complication rate was 13.3% vs. 10.0%, which was comparable. No major complication occurred.

Conclusions: The randomized controlled trial demonstrates that SRBS for renorrhaphy during retroperitoneal laparoscopic partial nephrectomy is safe and efficient. Application of barbed suture simplifies the parenchymal repair procedure and reduces warm ischemia time in comparison with conventional suture.