摘要
目的探讨T_1期肾癌术前DSA超选择性肾动脉栓塞后行腹腔镜下零缺血肾部分切除术的可行性与安全性。方法 2015年11月~2016年9月13例T_1N_0M_0期肾癌术前由同一介入科医师行肿瘤供血动脉DSA超选择性肾动脉栓塞,栓塞后1~15 h由同一个泌尿外科医生行腹腔镜下零缺血肾部分切除术。结果 13例均在腹腔镜下完成手术,无中转开放手术。2例因术中出血较多行肾动脉主干暂时性阻断,阻断时间分别为8、12.5 min,其余11例均按预期顺利完成手术,无输血。平均手术时间82 min(48~125 min),平均出血量130 ml(40~260 ml)。术后病理均为肾透明细胞癌。13例术后平均随访14.5月(12~18个月),均未见肿瘤复发和(或)转移。结论 T1期肾癌术前DSA超选择性肾动脉栓塞后行腹腔镜下零缺血肾部分切除术是安全可行的,尤其对于孤立肾肿瘤、肾功能不全以及引起肾功能下降的慢性病患者是较好的选择,值得推广。
Objective To discuss the feasibility and safety of zero ischemia laparoscopic partial nephrectomy after preoperative superselective transarterial embolization of the T1 renal cancer. Methods We retrospectively analyzed the data of 13 patients who accepted zero ischemia laparoscopic partial nephrectomy after superselective transarterial embolization from November 2015 to September 2016. All tumors were stage T1 N0 M0,with an average diameter of 4. 2 cm（ range,4. 0-5. 5 cm）. The superselective transarterial embolization was performed by the same interventional practitioner,and the zero ischemia laparoscopic partial nephrectomy was carried out by the same surgeon in 1-15 hours after superselective transarterial embolization. Results Laparoscopic partial nephrectomy was completed in all the patients. There was no conversion to open surgery. Because of hemorrhage the renal arterial trunk was temporarily blocked for 8 minutes and 12. 5 minutes in 2 cases,and the remaining 11 cases were all operated smoothly. The blood transfusion was not needed. The average operation time was 82 minutes（ range,48-125 minutes）. The average blood loss was 130 ml（ range,40-260 ml）. The average follow-up time was 14. 5 months（ range,12-18 months）. No reccurence or metastasis occurred.Conclusion It is a safe and feasible procedure for zero ischemia laparoscopic partial nephrectomy after preoperative superselective transarterial embolization of the T1 renal tumor,especially for patients combined with isolated renal tumor,renal insufficiency,and chronic diseases leading to renal dysfunction.
作者
干思舜
王磊
叶剑青
田毅君
曲发军
储传敏
杨炜
崔心刚
Gan Sishun;Wang Lei;Ye Jianqing(Department of Urology,Third Affiliated Hospital,Second Military Medical University,Shanghai 201805,China)
出处
《中国微创外科杂志》
CSCD
北大核心
2018年第9期810-813,共4页
Chinese Journal of Minimally Invasive Surgery
基金
上海市科委医学引导类科技支撑项目(17411960200)
上海市卫计委青年项目(20174Y0175)
关键词
栓塞
肾癌
腹腔镜肾部分切除术
零缺血
Embolization
Renal cancer
Laparoscopic partial nephrectomy
Zero ischemia
