选择性肾段动脉阻断的后腹腔镜肾部分切除术23例报告

目的:初步评估选择性肾段动脉阻断的后腹腔镜肾部分切除术的可行性和安全性。方法:采用后腹腔镜下结合术前血管三维成像及术中探查,分离并选择性临时阻断肾肿瘤的供血肾段动脉,对23例单发肾肿瘤患者行肾部分切除术。统计手术时间、术中出血量、肾段动脉阻断时间及围术期并发症。术后1、6个月随访行CT检查及血清肌酐,GRF测算,部分患者行SPECT复查。结果:23例手术均于腔镜下完成,其中2例行双支肾段动脉阻断,2例加行肾动脉主干阻断,15例行集合系统修复,5例缝合开放的可见血管。平均手术时间144min,平均肾段动脉阻断时间26min,平均出血量65ml。肾癌、错构瘤及肾脓肿分别为17、5、1例,均无切缘阳性。漏尿15天并伤口感染1例,23例均无术后继发出血,初步随访无肿瘤局部复发,无尿外渗,肾功能无显著变化。结论:选择性段动脉阻断的后腹腔镜肾部分切除术,术中出血较少,病灶切缘和集合系统辨认清晰;避免了患肾余留组织的热缺血及缺血后再灌注损伤,最大限度保留了肾功能。初步观察手术安全可行。

Retroperitoneal laparoscopic partial nephrectomy with selective blockage to renal segmentary artery(Report of 23 cases)

Objective:To preliminarily assess the application and safety of retroperitoneal laparoscopic partial nephrectomy with selective blockage to renal segmentary artery.Methods:23 cases with single renal mass underwent retroperitoneal laparoscopic partial nephrectomy in which renal segmentary artery for renal mass was separated and selected then temporarily blocked through pre-operative spiral CT three-dimensional angiography combined with surgical probing.Statistical data of operational duration,blood loss,renal segmentary artery blockage duration and peri-operative complications were gathered.The follow-up including CT scan,determination of serum creatinine and GRF was respectively conducted on all cases in the first month and sixth month after operation,SPECT scan was performed on some cases again.Results:23 cases were completed under laparoscope,in which blockage on dual renal segmentary arteries was performed in 2 cases,additional blockage on renal artery trunk was performed in 2 cases,repair on collective system was performed in 15 cases,suture of ruptured blood vessels was performed in 5 cases.The average operation duration was 144 minutes,the average time for the selective blockage to renal segmentary artery was 26 minutes,the average blood loss was 65ml.17 cases were renal carcinoma,5 cases were renal angiomyolipoma,1 case was renal abscess.Surgical margin was negative pathologically in all cases.15-day course of urine leakage complicated with incision infection occurred in 1 case.Secondary bleeding was absent in all cases,the preliminary follow-up showed no indication of local recurrence and urinous infiltration,the renal function of the spared nephron indicated no significant decrease.Conclusions:Retroperitoneal laparoscopic partial nephrectomy with selective blockage to renal segmentary artery has the benefits such as relatively less bleeding,clear identification of lesion focus incising margin and collective system,the warm ischemia and ischemical reperfusion injury of the spared nephron being avoided and the renal function preserved to the utmost,it is safe and applicable based upon preliminary observation.