后腹腔镜肾部分切除术治疗肾脏肿瘤  

Clinical application of Retroperitoneal laparoscopic partial nephrectomy on renal tumor

作　　者：丁炜宏 孙传玉[1] 苟元成 胡青峰[1] 徐可[1] 夏国伟[1] 丁强[1] 张元芳[1] 

机构地区：[1]复旦大学附属华山医院泌尿外科,上海200040

出　　处：《微创泌尿外科杂志》2013年第2期107-110,共4页Journal of Minimally Invasive Urology

摘　　要：目的:评价腹腔镜技术进行肾部分切除术的可行性及临床价值.方法:2005年3月～2011年7月,对经病理证实的145例肾癌患者,60例错构瘤患者在全麻下行后腹腔镜肾部分切除术.术中充分游离肿块；游离出肾动脉并用血管夹阻断(30 min内),用剪刀或超声刀切除肾占位肿块(切缘0.5～1.0 cm),保证肿块包膜完整；切面彻底止血,有血管出血缝扎止血；切开肾盂者,缝合关闭；然后全层兜底交错缝合切缘,缺损较大可用Hem-o-lok减张缝合.结果:所有患者均成功完成手术,手术时间60～150 min,平均80 min.阻断动脉10～30 min,平均20 min.术中出血量100～800ml,平均200ml,早期1例术后当晚出血,开放手术修复成功；2例术后缝合口出血,介入栓塞治疗满意；3例术后1～2周假性动脉瘤,介入栓塞治疗满意；无尿漏发生.其余恢复顺利,住院7～10天,平均8天,随访6～56个月,无肿瘤复发.结论:后腹腔镜肾部分切除术,创伤小、术后恢复快,明显优于开放手术,值得大力推广.但应注重基本功训练,严格掌握适应证.Objective:To evaluate the technical feasibility and clinical efficacy of laparoscopic partial nephrectomy(LPN).Methods:Between March 2005 and June 2011,Retroperitoneal laparoscopic partial nephrectomy was performed on 205 patients with exophytic tumors(145 of renal carcinoma and 60 of renal harmatoma confirmed with pathology).Mean age was 52-year(range:32-75-year).In all cases hilar were controlled by clamping the renal artery alone with endoscopic bulldog clamps within 30 minutes.Renal masses were excised with cold endoscissors.Hemostasis and repair of the collecting system were achieved by suture with 2-0 VICRYL.Results;Median tumor size was 2.8 cm(range:1-5 cm).All of 205 operations were successfully performed,with a mean surgical time of 80 minutes(range 60 min to 150 min),and blood loss of 200 ml(range 100 to 800 ml),clamping time 20 min(range 9 to 30 min).Pathologic diagnosis:145 renal-cell carcinoma;60 hamartoma,all surgical margins were negative.1 case suffered from bleeding at the operation night,and 2 cases bled two days later.For the 3 cases,we achieved a satisfy result by intervention embolization.Another 3 cases suffered from pseudoaneurysm 2 weeks after operation.we applied the intervention embolization and patients were cured.There were no patients suffering urinary fistula.The median follow-up for 205 cases is 36 months with a range between 6 to 56 month and no recurrence or metastasis were noted during our observation.Conclusions:Retroperitoneal laparoscopic partial nephrectomy has been proved to have distinct advantages of minor trauma and quick recovery compared with open partial nephrectomy.But the indication of operation should be strictly mastered.

关 键 词：后腹腔镜 肾肿瘤 肾部分切除术 

分 类 号：R737.1[医药卫生—肿瘤]