腹腔镜下非阻断肾蒂的低危肾癌 保留肾单位手术临床分析

The clinical analysis of laparoscopic nephron-sparing surgery without hilar clamping for low risk of renal neoplasm

摘要:

目的 探讨腹腔镜下不阻断肾蒂行肾部分切除术治疗肾肿瘤的手术技巧与临床应用效果。方法 2010年1月~2013年6月采用腹腔镜在不阻断肾蒂情况下对26例肾肿瘤行保留肾单位手术，均采用经腹途径，应用超声刀和双极电凝切除肾肿瘤，止血纱布填压及肾实质创面缝合的方法操作，观察手术时间、术中出血量、术后住院天数和术中、术后并发症及手术效果。结果 26例手术全部获得成功，平均手术时间为90 min；平均出血量145 mL，平均术后住院时间为8 d，手术效果好，无并发症，随访6～36个月，未见肿瘤转移或复发。结论 不阻断肾蒂行腹腔镜下保留肾单位手术安全可靠，避免了肾脏热缺血对肾功能的影响。

Abstract:

【Objective】 To evaluate the feasibility and clinical efficacy of laparoscopic nephron-spring surgery without hilar clamping for renal tumor. 【Methods】 From January 2010 to June 2013, 26 patients with renal tumor underwent laparoscopic nephron-sparing surgery without hilar clamping in our hospital. The 26 cases were treated by trans-peritoneal approach, using the hemostatic of harmonic scalpel, bipolar cautery and renal parenchyma defect suturing over surgical bolsters. The operating time, estimated blood loss, length of postoperative hospital stay, complications and surgical results were recorded. 【Results】 In all the patients, the procedures were done without conversion to open surgeries. The mean operation time was 90 min (70~155 min), and the mean blood loss was145 mL (40~350 mL). The mean postoperative hospital stay was 8 d (6~13 d). No complications occurred after the operation. During the 6~36 months follow-up, no recurrence of tumor was found. 【Conclusion】 Laparoscopic nephron-sparing surgery without hilar clamping is feasible and safe for patient, which avoid the effects of renal ischemia on renal function.