摘要
目的探讨无肾蒂阻断腹腔镜技术在保留肾单位手术治疗T1a期肾癌的经验。方法回顾性分析2011年12月至2016年3月烟台毓璜顶医院对32例和56例T1a期肾癌分别施行无肾蒂阻断及肾蒂阻断腹腔镜下肾部分切除术的临床资料。结果 2组肾癌患者均顺利完成腹腔镜下肾部分切除术,均采用后腹腔途径手术。其中无肾蒂阻断组手术时间32~64 min,平均49 min;术中出血量30~210 ml,平均120 ml;术后放置肾周引流管23例,引流量18~56 ml,平均32 ml;术后住院时间3~5 d,平均3.8 d;术后1周复查术侧放射性核素断层扫描(ECT)30~65 ml/min,平均50 ml/min;肌酐59~110μmol/L,平均75μmol/L。肾蒂阻断组手术时间36~77 min,平均58 min;其中热缺血时间18~35 min,平均23 min;术中出血量18~87 ml,平均53 ml;术后放置肾周引流管48例,引流量20~49 ml,平均29 ml;术后住院时间3~7 d,平均4.1 d;术后1周复查术侧ECT 31~54 ml/min,平均46 ml/min;肌酐58~123μmol/L,平均86μmol/L。两组术后病理报告均为肾透明细胞癌,切缘病理均阴性。术后复查肌酐较术前均无明显波动,但术后术侧肾ECT较术前差异有统计学意义。术后随访3~40个月,平均18.3个月,肿瘤无复发转移。结论无肾蒂阻断腹腔镜下保留肾单位手术治疗小肾癌安全可行,适宜病例的选择以及熟练的腹腔镜技术有助于此术式的开展。
Objective To report our initial experiences of laparoscopic nephron-sparing surgery(LNSS) for T1 a renal cell carcinoma without renal pedicle occlusion. Methods The clinical data with stage T1 a renal cell carcinoma from December 2011 to March 2016 in Yantai Yuhuangding hospital were retrospectively analyzed, including the clinical data of 32 laparoscopic partial nephrectomy without renal pedicle occlusion and the renal pedicle occlusion of 56 cases in the same period. Results Two groups of the operations were successfully accomplished with retroperitoneal approach. No renal pedicle occlusion group operation time was 32-64 min, average 49 min; bleeding 30-210 ml, average intraoperative 120 ml; After the operation, 23 cases of perirenal drainage tube were placed, and the flow rate was 18-56 ml, with an average of 32 ml; postoperative hospitalization time 3-5 d, average 3.8 d; After 1 week postoperatively ECT 30-65 ml/min, average 50 ml/min; creatinine 59-110 μmol/L, average 75 μmol/L. Renal pedicle occlusion group operation time was 36-77 min, average 58 min; and the warm ischemia time was 18-35 min, average 23 min; the intraoperative blood loss was 18-87 ml, average 53 ml; After the operation, 48 cases of perirenal drainage tube were placed, and the flow rate was 20-49 ml, with an average of 29 ml; postoperative hospitalization time 3-7 d, average 4.1 d; After 1 week postoperatively ECT 31-54 ml/min, average 46 ml/min; creatinine 58-123 μmol/L, average 86 μmol/L. Two groups of postoperative pathological reports were clear cell renal cell carcinoma, the margin of pathological was negative. There was no significant difference in postoperative creatinine compared with preoperative, but the postoperative renal ECT was statistically significant. All patients were followed up for 3-40 months with an average of 18.3 months. Conclusions LNSS for T1 a renal cell carcinoma could be performed safely with good outcomes. The skilled laparoscopic technology with suitable cases might facilitate the operations.
出处
《中华临床医师杂志（电子版）》
CAS
2017年第2期230-233,共4页
Chinese Journal of Clinicians(Electronic Edition)
关键词
肾肿瘤
腹腔镜检查
肾蒂阻断
肾部分切除术
Kidney neoplasms
Laparoscopy
Renal pedicle occlusion
Partial nephrectomy
