腹膜后腹腔镜保留肾单位手术治疗肾肿瘤的临床体会(附12例报告)

目的:探讨腹膜后腹腔镜保留肾单位手术治疗肾肿瘤的手术方法与临床疗效。方法:回顾分析为12例肾肿瘤患者行腹膜后腹腔镜保留肾单位手术的临床资料,术中用Bulldog夹钳夹肾动脉,冷剪刀剪除肿瘤,连续缝合并用Hem-o-lok收紧缝线,代替打结。观察手术时间、热缺血时间、术中出血量、围手术期并发症及手术疗效。结果:12例手术均获成功,无中转开放手术。手术时间平均(136±28.0)min,热缺血时间平均(27±7.9)min,术中出血量平均(126±83.1)ml。术后病理报告为肾透明细胞癌10例,血管平滑肌脂肪瘤2例。术后1例贫血,白蛋白较低,考虑与患者既往有乙型病毒性肝炎、糖尿病有关,予以对症治疗后恢复正常,余者围手术期未见迟发性出血、尿漏等并发症发生。平均住院(11±3.8)d。术后平均随访(12±9.2)个月,无一例复发。结论:腹膜后腹腔镜保留肾单位手术治疗肾肿瘤疗效确切,手术创伤小,术后康复快,住院时间短,具备熟练腹腔镜操作技术的医师可将其作为首选。

Retroperitoneal laparoscopic nephron sparing surgery for the treatment of renal tumors:with a report of 12 cases

Objective:To evaluate the methods and clinical efficacy of retroperitoneal laparoscopic nephron sparing surgery for the treatment of renal tumors.Methods:Clinical data of twelve patients with renal tumor received retroperitoneal laparoscopic nephron sparing surgery were analyzed retrospectively.Bulldog clamps were used to clamp the renal artery.Cold scissor was used to resect tumors and Hem-o-lok was used for tightening thread after continuous suture instead of ligature when suturing the kidney parenchyma.The operative time,warm ischemia time,estimated blood loss,intraoperative and postoperative complications and the operative efficacy were recorded.Results:All the operations were successfully performed and no case was converted to open operation.The mean operative time was(136±28.0) min,mean warm ischemic time was(27±7.9) min,and mean blood loss was(126±83.1) ml.Pathological diagnosis was clear cell carcinoma in 10 cases,and angiomyolipoma in 2.One patient got anemia and low albumin,which was considered to be associated with hepatitis b and diabetes,and the albumin returned to normal after symptomatic treatment.There was no delayed hemorrhage or urinary leakage after surgery.The mean hospital stay was(11±3.8) d.No severe postoperative complications were found,and no recurrence was found in all the patients during the mean follow-up of(12±9.2) months.Conclusions:Retroperitoneal laparoscopic nephron sparing surgery for renal tumors has the advantages of definite effect,minimal invasion,quick recovery,and short hospital stay,surgeons who have skilled laparoscopic operation techniques can perform it as the first choice.