后腹腔镜肾蒂阻断下保留肾单位肾肿瘤手术（附6例报告）  

Retroperitoneai laparoscopic nephron-sparing surgery for renal tumor （a report of 6 cases）

作　　者：张显军[1] 卢子文[1] 俞洪元[1] 王天济[1] 丁崇标[1] 

机构地区：[1]温州医学院附属台州医院泌尿外科,317000

出　　处：《中国医师进修杂志（外科版）》2008年第10期23-25,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨后腹腔镜肾蒂阻断下保留肾单位治疗肾肿瘤的方法及手术技巧。方法收治肾脏外生性实体肿瘤6例患者，其中肾细胞癌2例，肿瘤直径分别为2．5cm和2．2cm；肾错构瘤4例，肿瘤直径为2．5～3．5cm。经后腹腔镜径路在自制的肾蒂阻断装置中阻断肾蒂，做保留肾单位的肾肿瘤手术，术中距肿瘤0．5—1．0cm处行肾脏部分切除术，创面缝合止血。结果6例手术均成功，手术时间120～210min，中位数150min。术中出血150～200ml，中位数170ml。肾蒂血流阻断时间18～33min，中位数22min。2例肾细胞癌术后切缘阴性。术后随访6～12个月，未见肿瘤残留及复发。结论后腹腔镜肾脏部分切除术中应用自制的肾蒂阻断装置，具有良好的止血效果、手术创伤小、视野清晰、操作方便、能最大限度地保留患肾等优点，术后恢复良好。Objective To evaluate the methods and efficacy of retroperitoneal laparoscopic nephron-spariug surgery for the treatment of renal tumor. Methods A total of 6 patients with renal tumors underwent retroperitoneal laparoscopic nephron-sparing surgery during warm ischaemia. Among the 6 cases, 2 had malignant tumor With the diameter of 2.5 cm and 2.2 cm,and 4 had renal angiomyolipoma with the diameter from 2.5 cm to 3.5 cm.The renal vessels were secured by a self-made equipment. Tumors were excised with a cold Endo-shear. Parenchymal edges were approximated using a absorbable hemostatic gauze. Results All procedures were successfully completed without open conversion. Mean surgical time was 150 minutes （range 120-210 minutes）. Mean ischaemia time was 22 minutes （range 18-33 minutes） and the mean blood loss was 170 ml （range 150-200 ml）. Surgical margins were negative in all patients.During a follow-up for 6-12 months, no patient had local or port site recurrence. Conclusions Retroperitoneal laparoscopie nephron-sparing surgery for renal tumor by using self-made equipment is safe and effective. This procedure has the advantages of minimal invasion, less blood loss, good vision, and rapid convalescence and so on.

关 键 词：肾肿瘤 腹腔镜检查 肾单位 

分 类 号：R737.11[医药卫生—肿瘤] R-332[医药卫生—临床医学]