摘要
目的探讨后腹腔镜下铥激光肾部分切除术治疗局限性肾肿瘤的安全性及有效性。方法回顾性分析2017年12月至2019年10月收治的23例局限性肾肿瘤患者的临床资料。其中男15例、女8例,年龄41~75岁,左肾肿瘤10例、右肾肿瘤13例,肿瘤直径1.1~3.4 cm,R.E.N.A.L.评分4~7分,零缺血指数0.8~7.0。23例患者均采用后腹腔镜零缺血铥激光肾部分切除术。结果23例患者中,20例在不阻断肾动脉的情况下完成后腹腔镜铥激光肾部分切除术,3例因创面出血明显而阻断肾动脉后切除肿瘤,并用倒刺线缝合创面。肿瘤切除时间12~25 min,平均(17.2±3.3)min;术中出血量40~200 ml,平均(114.0±54.5)ml;术后第1天创口引流量60~260 ml,平均(149.1±62.7)ml。术后住院时间4~7 d,平均(5.7±1.0)d。术前血肌酐36~102 mmol/L,平均(63.6±20.3)mmol/L;术后1个月血肌酐44~126 mmol/L,平均(72.4±21.8)mmol/L,差异无统计学意义(P>0.05)。术后均未发生继发性出血、感染、漏尿等严重并发症。术后病理提示肾透明细胞癌15例、血管平滑肌脂肪瘤2例、嫌色细胞癌2例、乳头状肾细胞癌4例,所有切缘均阴性,术后随访18个月均未见复发或转移。结论后腹腔镜联合铥激光肾部分切除术具有出血少、肾功能损伤小、肿瘤切除彻底等优点,为体积较小的局限性肾肿瘤的治疗提供了一种零缺血的手术方式。
Objective To investigate the safety and efficacy of retroperitoneal laparoscopic partial nephrectomy using thulium laser for localized renal tumor.Methods From December 2017 to October 2019,23 patients with localized renal tumors were treated.There were 15 males and 8 females,with the age of 41-75 years old.Ten cases were on the left side and 13 on the right side.The diameter of tumor was 1.1-3.4 cm,the R.E.N.A.L.score was 4-7,the zero ischemic index was 0.8-7.0.These 23 cases were treated by thulium laser assisted retroperitoneal laparoscopic partial nephrectomy without renal artery occlusion.Results Retroperitoneal laparoscopic partial nephrectomy using thulium laser was successfully performed in 20 patients without renal artery occlusion.Tumors of 3 patients was resected after renal artery occlusion due to hemorrhage,and the wound was sutured with barbed sutures.The tumor resection time was 12-25 min,with an average of(17.2±3.3)min,the estimated blood loss was 40-200 ml,averaging(114.0±54.5)ml,the postoperation drainage was 60-260 ml,with an average of(149.1±62.7)ml.The postoperative hospital stay was 4-7 days,averaging(5.7±1.0)days.The preoperative serum creatinine was 36-102 mmol/L,with an average of(63.6±20.3)mmol/L,and the serum creatinine one month of operative was 44-126 mmol/L,with an average of(72.4±21.8)mmol/L.There was no significant difference(P>0.05).No serious postoperative complications such as secondary bleeding,infection,or urine leakage occurred.Postoperative pathological results:15 cases of clear cell carcinoma,2 cases of angiomyolipoma,2 cases of chromophobe cell carcinoma,4 cases of papillary renal cell carcinoma.All cases was shown negative margins,and there was no recurrence or metastasis within 18 months.Conclusions Retroperitoneal laparoscopic partial nephrectomy using thulium laser provides a zero ischemia technique for the treatment of small localized renal tumor,with the advantages of less bleeding,less renal damage,and thorough tumor resection.
作者
王俊
杨登科
郭志新
潘天然
吴洪磊
WANG Jun;YANG Dengke;GUO Zhixin;PAN Tianran;WU Honglei(Department of Surgery Ⅲ,Zhumadian Hospital of Traditional Chinese Medicine,Zhumadian 463000,China;不详)
出处
《现代泌尿生殖肿瘤杂志》
2021年第5期261-264,共4页
Journal of Contemporary Urologic and Reproductive Oncology
关键词
局限性肾肿瘤
腹腔镜
铥激光
肾部分切除术
Localized renal neoplasm
Laparoscopes
Thulium laser
Partial nephrectomy
