腹腔镜下马蹄肾合并肾肿瘤根治性切除术（附2例报告）

目的：探讨并研究马蹄肾合并肾肿瘤的腹腔镜治疗方法、可行性分析及预后评价。方法：2008年10月～2010年12月对2例马蹄肾合并单侧肾脏肿瘤患者行腹腔镜下肾脏肿瘤根治性切除术。术前经B超、IVU和CT检查明确诊断，手术采用Karl Storz高清视频采集系统、超声刀、双极电凝，Hem—o-lok及其它腹腔镜常用器械共同完成。结果：2例手术均获得成功，无中转开放。手术时间分别为180min、100min（平均140min），其中马蹄肾峡部处理时间为60min、36min（平均48min）；术中平均出血量约150ml。术后绝对卧床2～3天，术后5～7天拔除导尿管，2例患者均未出现继发出血、感染等并发症。随访无局部复发及远处转移。结论：对于符合根治手术条件的马蹄肾合并肾肿瘤患者，首选的治疗仍为根治性肾切除术。然而腹腔镜手术可充分发挥其创伤小、出血少、恢复快等微创优势。术前充分估计变异血管，细致的腹膜后腔解剖，以及妥善处理峡部，是手术治疗的关键所在。

Laparoscopic Radical Heminephrectomy for Renal Cell Carcinoma in a Horseshoe Kidney (Report of 2 Cases)

Objective： To investigate and study the horseshoe kidney with Iaparoscopic treatment of renal tumors, feasibility analysis and prognosis. Methods：From October 2008 to December 2010,2 cases of horseshoe kidney with unilateral renal tumors underwent laparoscopic radical excision of renal tumors. Preoperative IVU and CT examination confirm the diagnosis, surgery by Karl Storz video capture system, ultrasonic scalpel, bipolar coagulation, Hem-o-lok and other commonly laparoscopic instruments. Results：2 patients were operated successfully, without conversion to open. The operating time was 180 min, 100min （mean time 140 min）, horseshoe kidney isthmus which processing time is 60rain, 36rain （mean time 48 rain） ; the mean blood loss was 150 ml. Absolute bed rest after 2--3 days, 5--7 days after removal of the catheter, 2 patients were not a secondary hemorrhage, infection and other complications. Follow-up no local recurrence and distant metastasis. Conclusions： Radical surgery for character sets conditions for horseshoe kidney with renal cancer patients, the treatment of choice remains radical nephrectomy. However, Iaparoscopic surgery can take advantage of less trauma, less bleeding and quicker re covery minimally invasive advantages. Fully assess the variation of blood vessels before surgery, careful dissection of retroperitoneal cavity, and the proper handling of the isthmus, are the keys for surgical treatment.