腹腔镜肾部分切除术治疗复杂性肾囊性病变

目的：评价腹腔镜肾部分切除术治疗复杂性肾囊性病变的可行性、安全性与初步疗效。方法：回顾性分析北京大学第三医院泌尿外科2008年5月至2011年4月采用腹腔镜肾部分切除术治疗复杂肾囊性病变患者27例，其中Bosniak分级 ⅡF级7例，Ⅲ级11例，Ⅳ级9例。平均直径(3.58±0.75) cm，其中4例病变直径大于4.0 cm。结果：所有腹腔镜肾部分切除术均通过腹膜后入路成功完成。手术时间100~160 min，平均(123.1±16.8) min，术中肾热缺血时间25~40 min，平均(29.7±3.5) min。术中出血量50~110 mL，平均(75.5±21.8) mL。术后住院时间4~6 d，平均(5.11±0.85) d。术后病理结果：单纯性囊肿10例（37.0%），成人型囊性肾瘤 2例（7.4%），混合性上皮间质瘤 1例（3.7%），肾细胞癌囊性变13例（48.1%），多房囊性肾细胞癌1例（3.7%）。术前Bosniak分级与术后病理结果比较，Bosniak ⅡF级恶性病变比例为14.3%，Ⅲ级为45.5%，Ⅳ级为88.9%。术后随访12~48个月（中位随访时间24个月），未见临床复发。结论：Bosniak分级系统虽然可以对肾囊性病变提供临床量化诊断依据，但是鉴别肿瘤良恶性仍存在困难。腹腔镜肾部分切除术治疗复杂肾囊性病变是一种安全、有效的微创手术选择。

Laparoscopic nephron-sparing surgery for treatment of complex cystic renal lesions

Objective:To evaluate the feasibility,efficacy and safety of laparoscopic partial nephrectomy for complex renal cystic lesions.Methods: A retrospective cohort study was conducted on the clinical data of 27 patients with complex renal cystic lesions treated by laparoscopic partial nephrectomy from May 2008 to April 2011 in Peking University Third Hospital.According to the Bosniak classification,7 cases were lesions of grade ⅡF,11 of grade Ⅲ,and 9 of grade Ⅳ.The mean diameter of cystic lesions was(3.58±0.75) cm,and 4 lesions were larger than 4.0 cm.Results:All procedures were performed through retroperitoneal approach and successful.The mean operative time was(123.1±16.8) min,ranging from 100 min to 160 min,and the mean renal warm ischemia time was(29.7±3.5) min,ranging from 25 min to 40 min.Blood loss in the operations was from 50 mL to 110 mL,the mean being(75.5±21.8) mL.The postoperative hospital stay was 4 to 6 days,and the mean was(5.11±0.85) days.Postoperative pathological results included 10 simple renal cysts(37.0%),2 cases of adult cystic nephroma(7.4%),1 mixed epithelial and stromal tumor(3.7%),13 cases of renal cell carcinoma with cystic change(48.1%),and 1 multilocular cystic renal cell carcinoma(3.7%).The results showed that 14.3% of cystic lesions of grade ⅡF,45.5% of grade Ⅲ and 88.9% of grade Ⅳ were malignant.In the follow-up ranging from 12 to 48 months(median 24 months),there was no case of recurrence.Conclusion: The differentiation between benign and malignant renal cystic lesions before surgery remains difficult.According to the Bosniak classification,radiological diagnostic findings are standar-dized,but still limited in the accuracy to determine the dignity of pathological entity.Laparoscopic partial nephrectomy is feasible to treat complex renal cystic lesions,and is a safe and effective minimally invasive option.