腹腔镜辅助下自体肾移植术治疗复杂肾肿瘤

目的探讨腹腔镜辅助下自体肾移植术在复杂肾肿瘤治疗中的应用。方法回顾性分析2018年5月始3例接受腹腔镜辅助下自体肾移植术治疗患者围手术期与随访资料。3例患者中右肾血管平滑肌脂肪瘤伴肾静脉及下腔静脉瘤栓1例,左侧功能性孤立肾巨大肾癌1例,完全内生性T1a期肾癌1例。肾脏切除手术在腹腔镜辅助下完成,肾脏取出体外后立即进行肾脏灌注,并在冷缺血状态下切除肾肿瘤并行肾脏修补,然后将肾脏移植于髂窝内。结果3例患者手术均获成功,手术时间分别为330 min、280 min、220 min,手术失血量100~200 mL,肾热缺血时间20~60 s,围手术期无输血,术后无继发性出血、尿瘘等并发症。随访时间10~18个月,患者移植肾功能良好,未发现肿瘤复发或转移,无肾积水及肾动脉狭窄等。结论腹腔镜辅助下自体肾移植术是需要保留肾脏的复杂肾肿瘤患者安全有效的治疗选择。这项治疗方法可以帮助特定患者保留脏器,提高生活质量。

Laparoscopic Assisted Autologous Kidney Transplantation for Complex Renal Tumors

Objective To summarize the safety and efficacy of Laparoscopic nephrectomy and renal autotransplantation for the treatment of patients with complex renal tumor.Methods A retrospective analysis of perioperative and follow-up data of 3 renal tumor patients who received laparoscopic nephrectomy and autotransplantation.Of these three patients,1 case is right renal angiomyolipoma with vena caval and renal vein thrombus,1 case is functional solitary renal cell carcinoma and 1 case is complete endogenic renal carcinoma.Operations were performed under general anesthesia,kideys were harvested laparoscopically and the renal lesions were removed.The kidney autotransplantation were performed in the pelvis.Results 3 operations were performed successfully in duration time which were 330 min,280 min,220 min and the warm ischemia duration time range from 20 to 60 seconds while the estimated blood loss range from 100 to 200 mL and none of the patients accept allogenic blood transfusion perioperatively.Surgical complications such as secondary hemorrhage and urinary leakage had not been recorded.During the follow-up period of 10 to 18 months,the kidney grafts function were normal and no signs of renal tumor recurrence were found.Conclusion Laparoscopic nephrectomy with autotransplantation is safe and effective in patients with complex renal tumor.This treatment can help target patients with organ preservation and improving life quality.