后腹腔镜下肾部分切除术在R.E.N.A.L.评分为中度复杂性肾癌中的应用  

Application of retroperitoneal laparoscopic partial nephrectomy in renal carcinoma with intermediate complexity R.E.N.A.L. score

作　　者：张东旭[1] 滕竞飞[1] 李勋钢[1] 崔心刚[1] 陈杰[1] 王军凯[1] 李尧[1] 陈露[1] 汪凯[1] 徐丹枫[1] 

机构地区：[1]第二军医大学附属长征医院泌尿外科,全军泌尿外科中心,上海200003

出　　处：《临床泌尿外科杂志》2012年第10期737-740,共4页Journal of Clinical Urology

摘　　要：目的:探讨后腹腔镜下肾部分切除术在肾脏肿瘤测量评分系统(R.E.N.A.L.评分)为中度复杂性肾癌中的应用。方法:回顾性分析2005年4月～2011年6月82例R.E.N.A.L.评分为中度复杂性(7～9分)肾肿瘤患者的临床资料,其中男51例,女31例,平均年龄(53.2±9.8)岁。肿瘤平均直径(3.0±0.9)cm,其中左侧36例,右侧46例;背侧48例,腹侧34例;肿瘤靠近肾门血管11例,82例患者均行后腹腔镜肾部分切除术。结果:所有手术均顺利完成,无中转开放,围手术期无严重并发症。平均手术时间(102.0±23.1)min,术中平均热缺血时间(17.3±4.6)min,术中平均出血量(26.8±7.9)ml,术后平均住院时间(5.0±1.2)d,术后尿漏3例,留置导尿及输尿管导管后1周症状消失;术后肌酐短暂升高8例,均在6周内降至正常范围;术后平均随访(33.5±11.6)个月,80例患者术后6个月预估肾小球率过滤(eGFR)较术前无统计学意义,另2例患者eGFR分别下降30%、35%;术后肾功能长期维持在CKD3期和CDK2期分别为2例和3例,均未行血液透析治疗,余患者未发生肾功能不全;所有患者随访期间未见肿瘤复发及转移。结论:后腹腔镜肾部分切除术治疗R.E.N.A.L.评分为中度复杂性肾癌安全、有效,但其远期疗效尚需大样本对照研究和长期随访观察。Objective：To study the application of retroperitoneal laparoscopic partial nephrectomy in renal carcinoma with intermediate complexity R. E. N. A. L. score. Method.. From April 2005 to June 2011,82 cases（51 males and 31 females）of intermediate complexity R. E. N. A. L. score（range from 7 to 9 score）renal cell carcinoma were retrospectively analyzed. Mean age was（53.2±9.8）years,mean tumor size was（3.0±0.9）cm in diatneter, with 36 cases on the left side and 46 cases on the right side. Tumor located anteriorly in 34 cases,and 48 cases were located posteriorly. 11 cases of tumor were near the renal hilum. All 82 patients received retroperitoneal laparoscopic partial nephrectomy. Result： Eighty-two cases were operated successfully without conversion to open surgery, no severe perioperative complications. The mean operation time was（102.0 ± 23.1）min, and mean warm ischemia time（WIT） was （ 17.3 ± 4.6 ）min, and mean blood loss was （ 26.8 ±7.9 ） ml, ; mean postoperative hospital stay was（5.0± 1.2）days. Postoperative urinary leakage in three cases, symptoms disappeared one week after indwelling catheterization and ureteral catheter. Serum creatinine transient increased in 8 cases after surgery,and fell to normal range within 6 weeks. In a mean follow up for（33.5--11.6）months,estimated glomerular filtration rate （eGFR）6 months after operation was no statistical significance compared with preoperation in 80 cases,another 2 patients＇ eGFR decreased by 30% and 35%. Postoperative renal function remained in CKD3 period and CKD2 period were in 2 cases and 3 cases, none of these cases were treated with hemodialysis,and the remaining patients with normal renal function after surgery,no tumor recurrence and metastasis during follow-up in all cases. Conclusion： Treatment of retroperitoneal laparoscopic partial nephrectomy in renal carcinoma with intermediate complexity R. E. N. A.L. score is safe and effective,but its long-term effects still need to study by large samples wit

关 键 词：肾癌 后腹腔镜 肾部分切除术 治疗 

分 类 号：R737.11[医药卫生—肿瘤]