腹腔镜下肾部分切除术治疗T1a期肾癌59例

目的 探讨腹腔镜技术对T1a期肾癌(小肾癌)行肾部分切除术的经验.方法 2005年7月至2008年12月,对我院59例小肾癌患者施行腹腔镜下肾部分切除术,并对临床疗效进行了随访观察.结果 59例小肾癌施行腹腔镜下肾部分切除术均顺利完成.经腹腔途径27例,腹膜后途径32例,手术时间60～95 min,平均72 min.肾动脉阻断时间15～32 min,平均19 min.术中出血量20～50 ml,均未输血.术中需缝合集合系统2例.无大出血、尿漏等并发症发生.应用Hemo-lok钛夹替代缝线打结13例,其肾动脉阻断时间10～18 min,平均13 min,与传统缝线打结比较热缺血时间明显缩短(P<0.05).术后病理:肾透明细胞癌55例,颗粒细胞癌3例,嗜酸性细胞癌1例,切缘均阴性.术后住院时间5～10 d,平均6.2 d.术后复查双肾肾小球滤过率核素扫描及肌酐均正常,与术前比较差异无统计学意义(P<0.05).随访时间3～42个月,平均24.6个月,肿瘤无复发转移.结论 腹腔镜下肾部分切除术治疗小肾癌安全有效,熟练的腹腔镜技术有助于此术式的开展.应用Hemo-lok钛夹替代缝线打结可明显缩短肾脏热缺血时间,减少肾脏损伤.

Laparoscopic partial nephrectomy for small renal tumors: report of 59 cases

Objective To report our initial experiences of laparoseopic partial nephrectomy (LPN)for small renal tumors.Methods From July 2005 to December 2008, 59 patients with small renal tumors were resected by laparoscopic partial nephreetomy.Results All operations were successfully accomplished.Twenty-seven patients were treated via a transperitoneal approach and the other 32 cases a retroperitoneal approach.The average operative duration was 72 minutes ( range: 60-95 ) and the average kidney ischemia time 19 minutes (range: 15-32).The estimated blood loss was from 20-50 ml and no patient needed transfusion.The collecting system closure was performed by suture in 2 patients, and no complication of hemorrhage or urine leak was found.Thirteen cases used Hemo-lok to clamp the suture instead of traditional ligature.And the mean time of renal warm ischemia was 13 minutes (range: 10 - 18).These patients included 55 with clear cell renal carcinoma, 3 with granule cell renal carcinoma and 1 with oxyphil cell renal carcinoma.All renal tumors were completely removed with a negative surgical margin.The mean postoperative hospital stay was 6.2 days (range: 5 - 10).The postoperative ECT and creatinine were normal and there was no significant difference as compared with the preoperative findings(P <0.05).None patient had any local recurrence during a mean follow-up period of 24.6 months ( range: 3 - 42).Conclusions LPN for pT1 stage renal tumor is both safe and feasible.Mastering the skilled laparoscopic techniques may facilitate operation.Employing Hemo-lok instead of traditional ligature to clamp the suture while sewing renal wound shortens the warm ischemia time.