后腹腔镜保留肾单位手术治疗肾癌  

Retroperitoneal laparoscopic nephron sparing nephrectomy in treatment of renal tumor

作　　者：张刚[1] 吴长利[1] 胡海龙[1] 孙光[1] 

机构地区：[1]天津医科大学第二医院泌尿外科(天津市泌尿外科研究所),天津300211

出　　处：《中国内镜杂志》2011年第2期177-180,共4页China Journal of Endoscopy

摘　　要：目的探讨后腹腔镜保留肾单位手术(NSS)在治疗局限性肾癌中的临床应用。方法 2007年1月～2010年1月该院对29例局限性肾肿瘤患者行后腹腔镜NSS。选择临床分期T1a,单发且肿瘤直径2.2～4.0 cm(平均3.6 cm)的局限性肾肿瘤患者。术前逆行肾盂插管持续灌注4℃生理盐水实现对肾脏的低温保护,术中采用血管束带阻断肾动脉,用剪刀在距肿瘤5～10 mm处将肿瘤完整切除,后以可吸收缝线缝合及止血纱布压迫止血,2-0可吸收线做8字缝合肾实质,Hem-O-lok间断结扎代替打结。结果手术成功27例,1例术中因出血明显中转开放,1例因术后继发性大出血二次行经腹残余肾切除。术后病理报告透明细胞癌24例,嫌色细胞癌4例,后肾腺瘤1例。手术时间125(100～180)min;热缺血时间28(21～35)min。术中出血量130(60～500)mL;术后1例漏尿,留置双J管2周后自愈。住院时间7(6～14)d。术后随访29例,随访时间18(3～36)个月。患者术后肾功正常,肿瘤无复发及转移。结论后腹腔镜下NSS操作难度大,采用间隔Hem-O-lok结扎代替打结可以明显缩短手术时间和肾热缺血时间,降低操作难度;术前逆行肾盂插管灌注解决了肾低温保护和术后漏尿两个问题,有利于延长肾缺血时间、保护肾功能、减少并发症。【Objective】 To evaluate the clinic application effects in retroperitoneal laparoscopic nephron sparing surgery（NSS） for the treatment of small renal masses.【Methods】 Retroperitoneal laparoscopic nephron sparing nephrectomy was performed in 29 cases with small renal masses was retrospectively analyzed.Proceduce detailed as follow： before the produce,the ureter was cannulated with a 7 Fr single pigtail catheter by using retrograde access.Chilled saline（4 degrees C） irrigation was flushed through the catheter into the renal pelvis.Vessel bridle were used to clamp the renal artery and achieve warm ischemia.Cold scissoes was used to resect tumor distance 0.5~1.0 cm from margin of carcinoma then Hem-O-lok was used to clamp and control the artery bleeding in surgical bed instead of ligature when suturing the kindney parenchyma.【Results】 Pathological diagnosis was clear cell RCC in 24 cases,chromophobe RCC in 2 cases,metanephric adenoma in 1 case.operation time was 100~180 min,with mean warm ischemia time 21~35 min.Bleeding volume was 60~500 mL.hospitalization time 6~14 days.With 3~36 months follow-up,no tumor recurrence and metastasis was observed.【Conclusions】 Treatment by retroperitoneal laparoscopic nephron sparing nephrectomy for renal tumor could safe and efficient,but operative and skills are needed.The methods of intermittent suture and crossing Hem-O-lok could be used to shorten the operation time and complications.Besides,the ureter was cannulated with catheter by using retrograde access.It has resolved 2 problem in laparoscopic nephron sparing nephrectomy,that is,the achieving renal parenchymal hypothermia and the reduction of complications.

关 键 词：后腹腔镜 保留肾单位术 肾肿瘤 

分 类 号：R737.11[医药卫生—肿瘤]