摘要
目的 探讨不阻断或短时间阻断肾动脉行腹腔镜保留肾单位手术的临床效果. 方法 2004年9月～2006年11月,采用不阻断或短时间阻断肾动脉对29例肾肿瘤行腹腔镜保留肾单位手术.25例采用经后腹腔途径,4孔法操作,游离出肾动脉,血管束带绕过肾动脉后经套管引出体外,暂不阻断肾动脉,切除肿瘤表面及周围的肾脂肪囊,超声刀沿瘤体边缘外0.5 cm处分离,由浅入深,边切割边止血,直到完全切除肿瘤.若切除肿瘤过程中肾脏创面出血过多影响操作,可暂时阻断肾动脉并计时,迅速切除肿瘤,双极电凝止血后,即可开放肾动脉.止血纱布块填压肾脏创面,2-0可吸收线间断全层缝合肾实质创面,表面喷洒生物蛋白胶.4例采用经腹腔途径,肾下极找出输尿管,挑起后向肾门处游离,找出肾动脉,余步骤同腹膜外途径. 结果 29例均完成腹腔镜保留肾单位手术,术中20例未阻断肾动脉,9例阻断肾动脉,平均阻断时间14 min(5～20 min),平均手术时间165 min(105～240 min),平均出血量90 ml(20～800 ml),2例输血,无尿漏等其他并发症.术后住院时间平均9 d(7～17 d).18例肾癌平均随访9个月(1～26个月),肿瘤无复发. 结论 不阻断或短时间阻断肾动脉行腹腔镜保留肾单位手术安全可靠,但应选择未侵及肾脏集尿系统的外周型肿瘤.
Objective To evaluate the feasibility and clinical efficacy of laparoscopic nephron-spring surgery for renal tumor.Methods From September 2004 to November 2006,29 patients with renal tumor underwent laparoscopic nephron-sparing surgery without hilar clamping or with temporary hilar control in our hospital.The retroperitoneal approach was used in 25 patients with 4 trocars.During the operation,the renal artery was exposed and then the vessel bundles were pulled out of the abdominal cavity through one of the trocars,passing by the renal artery without clamping it.Afterwards,fatty cysts surrounding or on the surface of the tumor were resected.Tumor excision was then performed using ultrasonic shears.An incision was made at the point 0.5 cm away from the margin of the tumor,and was extended deeply to completely cut the tumor.Meanwhile,bleeding was controlled with bipolar diathermy.The renal artery was occluded when necessary so that the tumor could be cut within a limited time duration.And the occlusion could be re-opened after controlling the bleeding.After the procedure,the renal incision was compressed with gauze,sutured with 2-0 absorbable sutures,and covered with fibrin sealant.In the other 4 patients,trans-peritoneal approach was used.The ureter was exposed near the lower pole of the kidney and separated towards the renal hilum to find out the renal artery.The following steps were similar to the above mentioned. Results In all the patients,the procedures were done without conversion to open surgeries.In this series,20 operations were completed without clamping the renal artery;and in the other 9,the mean time of renal artery occlusion was 14 min(5-20 min).In our patients,the mean operation time was 165 min(105-240 min),and the mean blood loss was 90 ml(20-800 ml).Two of the patients received blood transfusion during the surgery.The mean postoperative hospital stay was 9 d(7-17 d).No complications,such as urine leakage,occurred after the operation.Eighteen patients were followed up for a mean of 9 months(1-26 month),no recurrence of tumor was found.Conclusion Laparoscopic nephron-sparing surgery without hilar clamping or with contemporary hilar control is feasible and safe for patients with peripheral renal tumor not involving the renal collecting system.
出处
《中国微创外科杂志》
CSCD
2007年第12期1186-1188,共3页
Chinese Journal of Minimally Invasive Surgery
关键词
腹腔镜
保留肾单位手术
肾肿瘤
肾血管
Laparoscopy
Nephron-sparing surgery
Renal neoplasms
Renal vessels
