摘要
目的:总结改良经腹膜后入路腹腔镜肾部分切除术治疗巨大囊性肾癌的操作体会。方法:共收治12例巨大囊性肾占位患者,肿瘤最大径56～78 mm,术前影像学检查考虑为囊性肾癌。术中先在经腹膜后入路腹腔镜视野下操作,分离出肾动脉备用,并尽可能分离部分囊性占位;然后改为开放手术操作,进一步完整分离出肿瘤,在完全长时间阻断前,行肾脏缺血预适应操作。完全阻断肾动脉,行肾部分切除术。采用"n+1"缝合技术,缝合肾脏创面。结果:12例患者均顺利完成手术。热缺血时间平均(29.1±7.2) min,术中出血量平均(256.5±40.1) m L,术后病理结果均提示为透明细胞癌,Fuhrman核分级Ⅰ级10例、Ⅰ～Ⅱ级2例。术后随访,均未见肿瘤复发,肾小球滤过率表现为较术前轻中度下降,6例患者存在部分肾盏轻度积水。结论:采用改良经腹膜后入路腹腔镜肾部分切除术治疗巨大囊性肾癌,同时达到了"保肾"、"去瘤"的两个目的,治疗效果较好。
Objective:To summarize the experience of improved laparoscopic partial nephrectomy via retroperitoneal pathway for huge cystic renal cell carcinoma.Methods:Clinical data of patients who suffered from huge cystic renal tumor were retrospectively analyzed.The maximum diameter was 56-78 mm.The tumors were considered as cystic renal carcinoma by preoperative imaging examination.Firstly,the operations were performed in the laparoscopic vision.The renal artery was separated and partial cystic lesion was exposed.Secondly,the operation was converted to open view and the tumor was exposed totally.The renal artery was blocked and partial nephrectomy was performed.Before total blocking,the renal artery underwent ischemic preconditioning.The“n+1”technology was adopted for the suture of renal wound.Results:All patients were performed such procedure successfully.The mean renal warm ischemia time was(29.1±7.2)min,the mean bleeding volume during operation was(256.5±40.1)mL.All of pathologic findings were clear cell carcinoma,10 cases were Fuhrman gradeⅠand the other 2 cases were gradeⅠ-Ⅱ.None of patient was found recurrence of tumor during follow-up after operation.The glomerular filtration rate of all cases were found mild-to-moderate decline and 6 cases were diagnosed as mild hydrocalycosis.Conclusions:The improved laparoscopic partial nephrectomy can attain both“protection of renal function”and“excision of tumor”.Using such improved operation can achieve good therapeutic effect for the huge cystic renal carcinoma.
作者
曲发军
潘秀武
刘溪
黄海
杨启维
叶剑青
干思舜
储传敏
崔心刚
QU Fa-jun;PAN Xiu-wu;LIU Xi(Department of Urology,the Third Affiliated Hospital of Second Military Medical University,Shanghai 200438,China;Gongli Hospital of the Second Military Medical University)
出处
《腹腔镜外科杂志》
2018年第12期947-950,共4页
Journal of Laparoscopic Surgery
基金
上海市科委医学引导类(中
西医)科技支撑项目(编号:17411960200)
上海浦东新区临床高峰学科(编号:PWYgf2018-03)
关键词
肾肿瘤
肾部分切除术
腹腔镜检查
腹膜后路径
改良
Kidney neoplasms
Partial nephrectomy
Laparoscopy
Retroperitoneal approach
Improved
