摘要
目的探讨不阻断肾动脉的零缺血腹腔镜肾血管平滑肌脂肪瘤(renal angiomyolipoma,RAML)剜除术的可行性及有效性。方法 2013年12月~2015年6月,行14例不阻断肾动脉的腹腔镜下RAML切除术,2例为孤立肾。右侧8例,左侧6例。单发11例,多发3例。肿瘤直径3.5~8 cm,平均4.5 cm。肿瘤位于肾脏上极5例,下极6例,肾窦内3例。10例经后腹腔途径,4例经腹腔途径。术中先游离肾动脉以备阻断。充分暴露肿瘤后,于肿瘤边缘标记切除范围,超声刀沿肿瘤边缘边切边用吸引器吸引,逐步切除肿瘤,用吸引器彻底吸除基底部残留肿瘤组织。小的肿瘤创面用V-Loc免打结缝线全层缝合,大的创面先缝合基底部止血并缩小创面,再缝合创面;肾窦内小的肿瘤切除后用止血材料填塞。结果 14例手术均成功,均未阻断肾动脉,无中转开放手术。手术时间54~87 min,平均67 min。术中出血30~350 ml,平均130 ml。术后无继发出血、漏尿及急性肾功能衰竭等并发症。随访5~12个月,平均8.3月,未见肿瘤残留及复发。结论不阻断肾动脉的状态下可以完成腹腔镜RAML剜除术。术前应完善影像学检查,了解肿瘤与肾脏血管的位置关系,术中要游离肾动脉做好阻断准备工作。
Objective To investigate the feasibility and clinical efficacy of laparoscopic off-clamp zero ischemia enucleation for the treatment of renal angiomyolipoma （RAML）.Methods From December 2013 to June 2015, 14 patients with RAML received laparoscopic off-clamp zero ischemia resection.The lesions were located on right side in 8 cases and on left side in 6 cases.Two cases were solitary kidney.Tumor was single in 11 cases and was multiple in 3 cases.The mean tumor diameter was 4.5 cm （range, 3.5-8 cm）.The tumors were located in the upper pole of kidney in 5 cases, in lower pole in 6 cases and in the renal sinus in 3 cases.Ten operations were completed by retroperitoneal and 4 operations were completed by transperitoneal approach.The renal artery was freed for blocking before freeing the tumor.The excisional range of the tumor was labeled to cut along the edge with the ultrasonic knife, sucking with the attractor to expose the visual field, removing the tumor gradually.After excision of the tumor, the residual tumor tissue in basal part was sucked with the attractor.The small tumor wound was sutured directly with V-Loc free-knot suture and the large tumor wound was sutured in two layers, which was sutured the base at the bottom at first to stop bleeding and narrow the wound and then closed the wound.The small wound in renal sinus was filled with hemostatic material directly.ResultsAll the procedures were successfully completed without conversion to open surgery or blocking the renal artery.The mean operation time was 67 min （range, 54-87 min） and mean blood loss was 130 ml （range, 30-350 ml）.There was no postoperative bleeding, leakage of urine, acute renal failure, and other complications.Follow ups for 5-12 months （mean, 8.3 months） found no tumor resided and recurred.Conclusions RAML can be excised in zero ischemia by laparoscopy without blocking the artery.Preoperative imaging should be done to understand the relationship between tumor and renal vessels.The renal artery should be carefully freed for blocking.
出处
《中国微创外科杂志》
CSCD
北大核心
2017年第7期637-640,共4页
Chinese Journal of Minimally Invasive Surgery
