腹腔镜保留肾单位肾肿瘤切除术147例报告

Laparoscopic nephron sparing nephrectomy in 147 cases

摘要:

目的 总结腹腔镜保留肾单位肾肿瘤切除术的手术经验。 方法 回顾分析该院2007年8月～2012年3月由同一术者施行的腹腔镜肾部分切除术147例临床资料，CT测量肿瘤最大直径1～7 cm（4.01±1.02）cm。术前肾血管CTA检查，发现变异肾动脉53例（36.05%），其中双支肾动脉31例（21.09%），多支肾动脉22例（14.97%）。 结果 147例均顺利完成手术，无1例中转开放，手术时间为35～98 （58.40±17.72）min；术中估计出血量20～130 （54.56±25.22）mL；术中热缺血时间0～37 （24.75±6.12）min。术中均未输血，术后并发症出现5例（3.40%）：血尿1例（0.68%），皮下气肿2例（1.36%），切口延迟愈合2例（1.36%）。经积极的术后处理后，均未见严重并发症。术后病理证实肾血管平滑肌脂肪瘤102例（69.39%），肾脏恶性肿瘤45例（30.61%）。 结论 腹腔镜保留肾单位肾肿瘤切除术治疗肾肿瘤安全、有效，值得应用和推广。

Abstract:

【Objective】 To summarize the experience of retroperitoneal laparoscopic management for nephron sparing surgery(NSS). 【Methods】 The clinical data of 147 patients who underwent laparoscopic partial nephrectomy (LPN) for treatment of kidney neoplasms from Aug. 2008 to Oct. 2012 were analyzed retrospectively, and the mass diameter was 1~7 cm(4.01±1.02) preoperative renal vascular CTA were performed. Among all patients, 53 patients (36.05%) had a variation of renal vessels. There were double renal arteries on one side (n =31, 21.09%), and multi-vessel renal arteries on one side(n =22, 14.97%). 【Results】 All procedures were successfully completed without conversion to open surgery. The mean operating time was (58.40±17.72)min ( range 35 to 98 min), mean bleeding volume was (54.56±25.22) mL (range 20 to 130 mL). The mean warm ischemia time was (24.75±6.12) min (range 0 to 37 min). All patients did not receive blood transfusion. Major perioperative complications were 1(0.68%) case of hematuresis, 2(1.36%) cases of subcutaneous emphysema, and 2(1.36%) had delayed union of incisions. The symptoms were improved after aggressive treatment. Pathology results showed 45 cases of renal carcinoma (30.61%), and 102 cases of angiomyolipoma (69.39%). 【Conclusion】 Retroperitoneal laparoscopic partial nephrectomy represents an effective and safe treatment option in the management of small renal cancer.