后腹腔镜技术治疗双侧肾癌的有效性与安全性研究

目的:探讨后腹腔镜技术治疗双侧肾癌的方法及疗效。方法:回顾性分析2004年1月～2010年6月11例双侧肾细胞癌患者的临床资料,同时型6例,异时型5例,肿瘤直径平均(2.8±1.8)cm。11例患者均分期行后腹腔镜手术治疗,其中8例行双侧肾部分切除术,3例行一侧肾癌根治及对侧肾部分切除术。结果:所有手术均顺利完成,无中转开放,平均手术时间(102±27)min,平均热缺血时间(23.0±7.7)min,术中平均出血量(80.0±43.5)ml,术后平均住院时间(10.6±2.0)d。术后平均随访(3.5±2.0)年,9例未见复发及转移且术后肾功能无异常,1例术后肌酐升高,1例肺转移予靶向药物治疗至今。结论:后腹腔镜技术治疗双侧肾癌安全、可行、有效,具有创伤小、恢复快的优点,但其远期疗效尚需大样本对照研究和长期随访观察。

Oncological efficacy and safety of retroperitoneal laparoscopic surgery for bilateral renal cell carcinoma

Objective:To present the experience of retroperitoneal laparoscopic surgery for bilateral renal cell carcinoma. Method:From January 2004 to june 2010,11 cases of bilateral renal cell carcinoma(BRCC)were retrospectively analyzed.Among the 11 csaes,6 had synchronous BRCC and 5 had asynchronous BRCC.The mean tumor size was(2.8±1.8) cm in diameter.All of the 11 patients received two-stage retroperitoneal laparoscopic operation.8 patients underwent bilateral retroperitoneal laparoscopic nephron-sparing surgery(LNSS),3 patients underwent unilateral retroperitoneal laparoscopic nephron-sparing surgery plus contralateral retroperitoneal laparoscopic radical nephrectomy(LRN). Result:11 cases were operated successfully without conversion to open surgery.The mean operation time was(102±27) min,and mean warm ischemia time(WIT)was(23.0±7.7) min,and mean blood loss was(80.0±43.5) ml,and mean postoperative hospital stay was(10.6±2.0) days.In a mean follow up for(3.5±2.0) years,9 patients’ renal function remains well without tumor recurrence and metastasis,1 patient serum creatinine up to abnormal level immediately after second surgery,1 had lung metastasis but still alive with targeted therapy. Conclusion:retroperitoneal laparoscopic surgery is safe、feasible and effective for BRCC with less trauma and faster recovery of its advantages,but its long-term effects still need to study with large samples compare and long-term follow-up.