后腹腔镜下保留肾单位的肾部分切除术14例临床分析

目的:探讨后腹腔镜下保留肾单位肾部分切除术的方法及临床应用价值。方法:分析2007年1月至2009年10月,我院行后腹腔镜下保留肾单位的肾部分切除术14例患者的临床资料。术前经超声、CT或MR I等诊断为肾脏肿瘤。直径2.2 cm-4.0 cm,平均2.9 cm;左侧9例,右侧5例;以2002年AJCC肾癌的临床分期为标准,均属于T1 a期。结果:手术均成功。手术时间100-140m in,平均110m in;热缺血时间22-39m in,平均30m in;术中出血量80-330m l,平均180m l;术后留置引流管5-10d,平均7d;术后引流量150-300m l,平均200m l;术后住院时间8-10d,平均9d;术中、术后均未输血;术后无继发出血、漏尿等并发症。术后病理诊断:肾细胞癌11例,肾血管平滑肌脂肪瘤3例,切缘均为阴性。随访3-30个月,所有患者均未见肿瘤局部复发、远处转移及切口种植等。结论:后腹腔镜下保留肾单位的肾部分切除术可以最大限度保存残肾的功能单位,对小于4 cm的肾肿瘤是有效和微创的治疗方法。远期疗效有待进一步观察。

Clinical analysis of retroperitoneal laparoscopic nephron-sparing surgery report of 14 cases

Objective:To investigate the method and value of retroperitoneal laparoscopic nephron-sparing excision.Methods: A retrospective analysis was made on clinical data of 14 cases diagnosed as renal mass by ultra-sound,CT or MRI who were treated by retroperitoneal laparoscopic nephron-sparing surgery from January 2007 to October 2009 in our hospital.The tumor diameters ranged from 2.2 to 4.0 cm with mean of 2.9 cm.All cases were clinical stage T1a according to the AJCC 2002.Results: All operations were successful.The average operative time was 110 min(100-140min);The average ischemic time was 30 min(22-39min);The average blood loss was 160 ml(80-300ml);The average post-operative draining time was 7days(5-10days);The average volume of draining was 200 ml(150-350 ml);The average post-operative stay time was 9 days(8-10days);All cases had no blood transfusion.Pathology showed renal cell carcinoma 11 cases,angiomyodipoma of kidney 3 cases.All cases showed negative surgical margins.No intraoperative complications occurred.The follow-up time was 3-36 months.Imaging examinations revealed no tumor local recurrence,distant metastasis and transplant metastasis at the Trocar wound.Conclusion: Retroperitoneal laparoscopic nephron-sparing surgery could maximally preserve the nephron and its function.It offers an effective and minimally invasive treatment for T1a renal tumor.The long term effects need further investigation.