后腹腔镜肾癌根治性切除术32例临床体会

目的探讨后腹腔镜肾癌根治性切除术的手术技巧及疗效。方法回顾分析2010-09—2015-10间行后腹腔镜肾癌根治性切除术的32例患者的临床资料。结果患者均成功完成手术,手术时间75~190 min,平均105 min,出血量30~400 m L,平均75 m L。术后病理均是肾细胞癌,术后随访3~36个月,未见肿瘤复发转移。结论后腹腔镜肾癌根治性切除术是治疗肾癌的一种安全有效微创的手术方法。     

Retroperitoneal Laparoscopic Pyelolithotomy in an Ectopic Pelvic Kidney

Background and Objectives:

Retroperitoneal laparoscopic pyelolithotomy was performed in an ectopic pelvic kidney with renal pelvis calculi.

Methods and Results:

Laparoscopic pyelolithotomy was successfully performed in an ectopic pelvic kidney by using the retroperitoneal route. The total operation time was 130 minutes, and the estimated blood loss was <50mL. The patient was discharged on the second postoperative day without any complications.

Conclusion:

Laparoscopic pyelolithotomy is an effective treatment option for management of stones in the pelvis of an ectopic pelvic kidney. The retroperitoneal route may help to avoid intraoperative and postoperative complications.     

Overall Survival and Development of Stage IV Chronic Kidney Disease in Patients Undergoing Partial and Radical Nephrectomy for Benign Renal Tumors

Background

Although partial nephrectomy (PN) has been associated with improved renal function compared with radical nephrectomy (RN) for renal cell carcinoma, the impact on overall survival (OS) remains controversial.

Objective

To evaluate comparative OS and renal function in patients following PN and RN for a renal mass where malignancy was not a confounding factor.

Design, setting, and participants

Using the Mayo Clinic Nephrectomy Registry, we retrospectively identified 442 patients with unilateral sporadic benign renal masses treated surgically with PN or RN between 1980 and 2008.

Outcome measurements and statistical analysis

The primary outcome measures were OS and the incidence of new-onset stage IV chronic kidney disease (CKD), determined using the Kaplan-Meier method. Cox models were used to test the association of nephrectomy type with these outcomes.

Results and limitations

Overall, 206 and 236 patients with benign renal masses were surgically treated with RN and PN, respectively. Patients who underwent RN were older (median age: 67 vs 64 yr; p = 0.02) and had larger tumors (median size: 5.0 vs 2.7 cm; p < 0.001). Median follow-up for patients still alive at last follow-up was 8.3 yr (range: 0.1–27.9 yr). Estimated OS (95% confidence interval [CI]) rates at 10 and 15 yr were 69% (62–76%) and 53% (45–62%) for RN compared with 80% (73–87%) and 74% (65–83%) following PN (p = 0.032). After adjusting for covariates of interest, patients treated with RN were significantly more likely to die from any cause (hazard ratio [HR]: 1.75; 95% CI, 1.08–2.83; p = 0.023) or develop stage IV CKD (HR: 4.23; 95% CI, 1.80–9.93; p < 0.001) compared with patients who underwent PN. Limitations include the retrospective design, selection bias for surgical approach, and referral bias to a tertiary care facility.

Conclusions

Our data suggest that PN may confer a clinical benefit for improved renal function and better OS compared with RN after excluding the confounding effect of malignancy.     

Robot-Assisted Laparoscopic Pyeloplasty with Stone Removal in an Ectopic Pelvic Kidney

Ectopic pelvic kidneys with ureteropelvic junction obstruction and stones present a treatment challenge for the minimally invasive surgeon. A pure laparoscopic approach is less invasive than an open approach but is technically difficult with longer operative time. The use of the da Vinci robotic interface has the potential to refine the laparoscopic technique and improve outcomes. Here, we present successful management using the robotic technique of one such case of concomitant pyeloplasty and pyelolithotomy.     

后腹腔镜肾癌根治术108例报告

目的探讨后腹腔镜下肾癌根治术的效果。方法2001年10月～2006年9月,行后腹腔镜下肾癌根治术108例。肿瘤大小1.0～8.0cm,(4.3±2.9)cm。术前临床分期:T1N0M042例,T2N0M054例,T3aN0M012例。结果手术时间35～180min,(63.5±30.3)min。出血量20～1500ml,(75±23)ml。中转开腹3例。并发症包括术中下腔静脉或肾静脉损伤出血4例,切口感染3例,高碳酸血症8例。全组随访6～36个月,其中61例>12个月,2例术后1年肺部转移死亡,1例术后7个月肝转移死亡,其余105例均无瘤生存。1年生存率98.4%(60/61),3年生存率85.7%(18/21)。结论后腹腔镜下肾癌根治术切口小,恢复快,效果好,值得临床推广。     

Laparoscopic Pyelolithotomy in a Pelvic Kidney: A Case Report and Review of the Literature

Background and Objectives:

Laparoscopic pyelolithotomy was performed in a pelvic kidney with a large renal pelvis calculus.

Methods and Results:

Laparoscopic pyelolithotomy was successfully performed in a pelvic kidney with an operative time of 310 minutes. The use of intraoperative fluoroscopy and a semi-automatic suturing device greatly facilitated the procedure. The patient''s operative pain was managed with 3 doses of ketorolac; she resumed a regular diet the day after surgery, and was discharged on the first postoperative day.

Conclusions:

For patients with a large stone in the renal pelvis of an ectopic kidney, laparoscopic pyelolithotomy provides an effective approach.     

Laparoscopic versus Open Partial Nephrectomy: Analysis of the Current Literature

Objectives

To critically review the current scientific evidence about open partial nephrectomy (OPN) and laparoscopic partial nephrectomy (LPN) to define the current role of these techniques in the treatment of renal tumours.

Methods

PubMed and Medline were searched for reports about OPN and LPN that were published from 1990 to 2007 and the most relevant papers were reviewed.

Results

OPN is an established curative approach for the treatment of small renal tumours. LPN is challenging and the technique is still under development. The intermediate-term oncologic and functional outcomes of LPN are similar to those of OPN in experienced centres. However, the ischaemia time is longer in laparoscopy and a long learning curve is needed to decrease the risk of complications. In the first phase of a surgeon's experience with LPN, a careful case selection based on the tumour growth pattern is required.

Conclusion

OPN is today the first treatment option for small renal tumours. LPN is technically challenging, but has been shown to achieve similar intermediate-term cancer cure and renal function results in centres with advanced laparoscopic expertise. Larger series with longer follow-up and prospective randomised studies are needed to confirm the safety and efficacy of LPN.     

Ectopic Adrenal Tissue as Radiographic Lymphadenopathy in Renal Cell Carcinoma

In the presence of solid, contrast-enhancing renal mass, concomitant contrast-enhancing retroperitoneal mass is usually viewed as regional lymph node metastasis unless proven otherwise. The present report of ectopic adrenal tissue demonstrates that the presence of retroperitoneal contrast-enhancing mass may be a benign finding in patients with renal malignancy. Pathology remains the definitive method for diagnosis in such situation.     

腹腔镜下广泛子宫切除、盆腔淋巴结清扫术治疗子宫恶性肿瘤

目的探讨腹腔镜广泛子宫切除、盆腔淋巴结清扫术治疗子宫恶性肿瘤的可行性及临床效果。方法比较2007年3月～2008年3月11例腹腔镜手术与同期26例开腹手术行广泛子宫切除、盆腔淋巴结清扫治疗的子宫内膜癌、子宫颈癌的临床资料,观察2组手术时间、术中出血量、淋巴结切除数量、术后病率、肠道排气时间、住院日等。结果腹腔镜组子宫内膜腺癌3例（ⅠB期2例,ⅡA期1例）,子宫颈鳞癌8例（ⅠA期1例,ⅠB期5例,ⅡA期2例）;开腹组子宫内膜腺癌7例（ⅠB期5例,ⅡA期2例）,子宫颈鳞癌19例（ⅠA期2例,ⅠB期14例,ⅡA期3例）。2组差异无显著性（P〉0．05）。与开腹组相比,腹腔镜组术中出血量少[（216．8±125．4）ml vs（402．1±135．2）ml,t=-3．889,P=0．000],切除淋巴结多[（19．9±6．5）个vs（14．6±5．6）个,t=2．510,P=0．017],术后排气早[（34．6±6．5）h vs（56．4±7．6）h,t=-8．300,P=0．000],住院时间短[（14．6±3．5）d vs（19．4±5．6）d,t=-2．622,P=0．013];2组手术时间、术后病率、尿潴留的发生率差异无显著性（P〉0．05）。2组分别随访（11．0±3．2）和（12．0±2．8）月,无复发证据。结论腹腔镜下治疗子宫恶性肿瘤创伤小,恢复快,是一种安全有效的手术方法。     

Transperitoneal Laparoscopic Nephrectomy for Autosomal Dominant Polycystic Kidney Disease

Objective:

This study focuses on laparoscopic nephrectomy for autosomal dominant polycystic kidney disease (ADPKD).

Material and Methods:

We retrospectively reviewed 21 consecutive patients who had previously undergone laparoscopy between 2007 and 2010. Data were compared to that obtained from 19 consecutive patients who had open surgery between 2004 and 2007. Clinical parameters, operative data, perioperative mortality, postoperative complications, and length of hospital stay were compared using χ² and Student t tests for qualitative and quantitative variables, respectively.

Results:

Nephrectomy is usually performed to create space for renal transplantation (81% and 79%, respectively). Operating time was longer with the laparoscopic approach (180 min vs. 128 min, P = .001). Blood loss was comparable in the 2 groups (154 vs. 222 ml, P = .359) but 3 patients were transfused in the open surgery group as compared with 1 patient in the laparoscopic group. No conversion was needed. There was a trend in the laparoscopic group with respect to lower consumption of analgesics in the postoperative period (P = .06). Delay to transit recovery (2.1 d vs 4.1 d, P < .001) and hospital stay (5.2 d vs. 8.28 d, P = .002) were significantly decreased in the laparoscopic group. The interval from surgery to renal transplantation was lower in patients operated on laparoscopically (3.1 vs. 12 mo). Complications occurred in 33% of the patients in the laparoscopic group as compared with 68% in the open surgery group (P = .22). Severe complications were less frequent in the laparoscopic group (9.5% vs. 37%, P = .04).

Conclusion:

Laparoscopic nephrectomy is a feasible and safe procedure for ADPKD. Morbidity is significantly reduced compared with the open approach.     

经腹腹腔镜肾癌根治术(附70例报告)

目的探讨经腹途径腹腔镜肾癌根治切除术的技术要点及临床价值。方法采用经腹途径腹腔镜肾癌根治术,切开侧腹膜后,首先处理肾蒂血管,然后行肾癌根治术。结果70例手术全部成功,无中转开放手术,手术时间90～230min,平均130min。术中及术后均未输血。2例切口感染,4例皮下气肿。术后住院4～8d,平均6.2d。70例随访2～78个月,平均47个月,无肿瘤复发。结论经腹途径腹腔镜肾癌根治术具有创伤小,安全有效,恢复快等优点,具有良好的临床应用前景。     

Laparoscopic Retroperitoneal Nephrectomy for Atrophic Kidney Associated with Ectopic Ureter in a 2-Year-Old Girl

A 2-year-old Japanese girl underwent laparoscopic retroperitoneal surgery for removal of an atrophic left kidney located in the left retroperitoneal space that was associated with an ectopic ureter. No serious complications developed during the operation or postoperatively.     

Transvaginal Route for Kidney Extraction in Laparoscopic Donor Nephrectomy

Background and Objectives:

The aim of this retrospective study was to compare conventional laparoscopic living-donor nephrectomy with transvaginal natural orifice transluminal endoscopic surgery–assisted living-donor nephrectomy in terms of feasibility and reproducibility.

Methods:

A total of 115 consecutive female patients who underwent laparoscopic living-donor nephrectomy (n = 70) or transvaginal natural orifice transluminal endoscopic surgery–assisted living-donor nephrectomy (n = 45) were included and compared in terms of operative characteristics, as well as donor and recipient outcomes.

Results:

No significant difference was observed between the laparoscopic living-donor nephrectomy and transvaginal natural orifice transluminal endoscopic surgery–assisted living-donor nephrectomy groups in terms of mean duration of warm and cold ischemia, operation time, length of hospital stay, arterial anastomoses, visual analog scale pain scores, serum creatinine levels, and receiver outcomes, whereas a significantly higher number of venous anastomoses was noted in the laparoscopic living-donor nephrectomy group than in the transvaginal natural orifice transluminal endoscopic surgery–assisted living-donor nephrectomy group (P = .029).

Conclusions:

Transvaginal natural orifice transluminal endoscopic surgery–assisted living-donor nephrectomy seems to be a feasible and reproducible alternative to conventional laparoscopic living-donor nephrectomy in female donors provided the viability of the vagina as an organ retrieval route.     

手助腹腔镜与标准腹腔镜根治性肾切除术的临床研究

目的探讨手助腹腔镜根治性肾切除术与标准腹腔镜根治性肾切除术的临床价值。方法回顾分析2010年1月至2011年12月本中心96例腹腔镜根治性肾切除术患者的临床资料,其中58例为手助腹腔镜组,38例为标准腹腔镜组。对比分析两组患者的术中、术后相关临床指标、并发症及短期随访结果。结果手助腹腔镜组和标准腹腔组的手术时间(65.3min和95.8min)、术中出血量(48.9ml和123.9ml)有明显统计学差异(P<0.05)。所有病例均进行了3～27个月的随访,均未发现肿瘤局部复发或远处转移。结论手助腹腔镜技术保留了腹腔镜手术创伤小、痛苦少、术后恢复快、并发症少等优点,并可缩短手术时间、减少术中出血及损伤周围脏器的风险。     

Ex Vivo Partial Nephrectomy and Partial Kidney Autotransplantation for Renal Pelvic Carcinoma in a Functionally Solitary Kidney: Case Report

A 46-year-old Japanese man was diagnosed with a left renal pelvic carcinoma and a contralateral hypoplastic kidney. The tumor was adjacent to the renal pelvis and was considered too difficult to completely resect in situ. The patient was treated by ex vivo partial nephrectomy of the left kidney followed by autotransplantation of the remaining renal segment. A pathologic evaluation revealed a transitional cell carcinoma, G2, pT3. Graft function recovered satisfactorily postautotransplantation and no significant complications developed during the postoperative period. The patient is alive and doing well 12 months postoperatively with no evidence of tumor recurrence.