腹腔镜肾部分切除术（附160例报告）

目的：介绍我院行腹腔镜肾部分切除术（LPN）的体会。方法：2004年1月～2009年11月采用腹腔镜经腹腔或后腹腔途径对160例肾肿瘤患者行LPN。局限性肾透明细胞癌135例，乳头状肾细胞癌6例，嫌色细胞癌2例，嗜酸细胞腺瘤2例，肾血管平滑肌脂肪瘤15例，肿瘤直径4．1cm（2．0～6．0cm）。左侧86例，右侧74例。观察手术时间、术中出血量、住院大数、并发症及手术效果。结果：160例手术均顺利完成。平均手术时间70min（40～150min），152例患者平均血管阻断时间26min（20～55min），8例患者未阻断肾血管。术中平均出血量75ml（10～300m1）。4例术后出现迟发出血，予以保守治疗。2例术后出现漏尿。平均住院时间7．5天（6～15天）。随访2～70个月肿瘤无复发。结论：LPN安全、有效，对肿瘤压迫集合系统的，腔镜下缝合也是安全有效的，随着手术技术的熟练，对复杂肾肿瘤行LPN，肾脏功能保留和肿瘤控制效果逐渐提高。

Laparoscopic Partial Nephrectomy (Report of 160 Cases)

Objective： To evaluate the clinical effect of laparoscopic partial nephrectomy（LPN for renal tumorsMethods：From January 2004 to November 2009,160 patients（117 men and 43 women） with renal tumors underwent transperitoneal or retroperitoneal LPN. Among the 160 cases, 135 had renal clear cell carcinoma, 6 had renal papillary carcinoma,2 had oncocytoma,2 had chromphobe and 15 had renal angiomyolipoma with a mean diameter of 4. 1 cm（range 2.0-6.0 cm）. The operative time, estimated blood loss, postoperative hospital stay, complications and the time of convalescence were recorded. Results： The operations were successfully performed in all patients. The mean operative time was 70 rain（range 40-150rain）. The mean estimated blood loss was 75ml（range 10 300ml）, the warm ischemia time was 26 min（range 20 55min） and no blood transfusion or conversion to an open procedure was required. The mean hospital stay was 7.5 d （range 6 15 d）. Complications occurred in six pa tients, postoperative hemorrhage occurred in four patients without requiring re-exploration. Two urine leaks resolved spontaneously. During a follow-up of 2-70 months, No tumor recurrence was found. Conclusions： LPN for renal tumors can be performed safely and effectively. In properly selected patients with a tumor extending to the collecting system, the LPN defect can be reconstructed safely with a running intraparenehymal suture. Contemporary LPN is a sophisticated procedure, and in expert hands, offers good functional and oncologic outcomes even for complex tumors.