保留肾单位的腹腔镜肾肿瘤切除手术方法及技巧

目的 介绍腹腔镜下钳夹法肾蒂阻断、锐性切除肿瘤以及创面直接缝合行保留肾单位的肾肿瘤切除术方法及手术技巧.方法 2003年6月至2005年6月,收治肾外生性实性肿瘤患者16例.男5例,女11例.年龄29～56岁,平均46岁.肿瘤位于左侧9例,右侧7例.肾细胞癌5例,肿瘤直径2.0～3.5 cm;肾错构瘤11例,肿瘤直径3.0～5.5 cm,其中1例肾错构瘤继发出血.经腹腔路径行保留肾单位的腹腔镜肾肿瘤切除术,手术在无损伤钳钳夹肾蒂控制血管后距肿瘤0.5～1.0 cm正常实质处锐性切除,创面缝合止血.结果 16例手术均成功.手术时间70～150 min,平均104min.肾蒂阻断时间14～32 min,平均21 min.术中出血量50～700 ml,平均158 ml.5例肾细胞癌患者病理检查示切缘阴性.16例术后无尿瘘、无继发出血,肾功能未见异常.2～4 d肛门排气,平卧1周出院.随访1～24个月,16例B超复查、11例CT检查肿瘤无复发,IVU复查肾显影良好.结论 可靠的肾血管控制是腹腔镜下行保留肾单位的肾肿瘤切除术的基本保证,无烟雾锐性切除肿瘤和创面的缝合处理能有效减少肾缺血时间,是保留、保护肾单位的有效手段,也是最有效的止血方法.本手术创伤小、出血少、痛苦少、并发症少、恢复快,能有效切除肿瘤和保留或保护肾功能.

Techniques of transperitoneal laparoscopic nephron - sparing surgery for renal tumors

Objective To report on our experience with laparoscopic nephron-sparing surgery forthe treatment of renal tumors,and to seek the safe and effective techniques and methods. Methods FromJune 2003 to June 2005,16 patients (5 men and 11 women) with small exophytic solid renal masses weretreated by transperitoneal laparoscopic wedge resection in our hospital.The mean age was 46 years (range,29 -56 years).The mean tumor size of renal cell carcinoma (5 cases) and hamartoma (11 cases) was2.0 -3.5 cm and 3.0 -5.5 cm,respectively, in diameter. One case of hamartoma had secondary bleeding.Wedge resection of the tumors was performed quickly with scissor,and hemostasis was achieved by intra-ab-domen suturing and knotting. Results All the procedures were finished laparoscopically with no conver-sion to open surgery.The mean operative time was 104 min (range,70 -150 min);mean hot bloodless timewas 21 min(range,14 -32 min);mean blood loss was 158 ml (range,50 -700 ml).The pathologic exami-nation showed negative surgical margin in 5 cases of renal cell carcinoma.Postoperatively,no urinary leakageand secondary bleeding occurred,and the renal function was normal in all the 16 cases.The patients weredischarged 7 d after operation.Follow-up was 1 month to 1 year.Neither distant nor local recurrences wereobserved by the last follow-up date on B-ultrasound,IVUand CTat follow-up. Conclusions Laparoscopicnephron-sparing surgery for renal tumors is a minimally invasive procedure with less blood loss,less pain andfewer complications.Reliable non-traumatic kidney vessel control is the basic method of this operation.Sharpresection without smog and rapid renal incision suturing can reduce the renal hot bloodless time.