高选择肾动脉阻断腹腔镜肾脏部分切除术治疗中央型肾肿瘤  

Laparoscopic partial nephrectomy for centrally located renal tumors by high selective renal artery block

作　　者：殷民[1] 林宁殊[1] 李如兵[1] 杨燮樵[1] 毛小强[1] 

机构地区：[1]宁波大学医学院附属李惠利医院泌尿外科,宁波315040

出　　处：《临床泌尿外科杂志》2012年第10期741-743,共3页Journal of Clinical Urology

摘　　要：目的:探讨中央型肾肿瘤腹腔镜肾部分切除术的手术技巧及结果。方法 :2006年6月～2011年6月,我院对8例中央型肾肿瘤施行腹腔镜下肾部分切除术。术中通过仔细游离肾蒂血管,选择性阻断或结扎滋养肿瘤的三级血管,以减少正常肾单位的热缺血时间和术中的出血。结果:8例手术均顺利完成,手术时间为150～300min,平均220min,肾血管阻断时间22～45min,平均33min。肿瘤大小为2.0～6.0cm,平均为2.8cm。需集合系统修补6例(75%)。术中出血量100～400ml,平均为130ml,均未输血。病理报告:肾透明细胞癌6例(75%),肾血管平滑肌脂肪瘤2例,术中及术后切缘均阴性。术后随访3～46个月,平均22.3个月,未见肿瘤局部复发或远处转移。结论:腹腔镜肾部分切除术治疗中央型肾肿瘤安全有效,选择性阻断或结扎滋养肿瘤的肾动脉三级分支可以有效减少正常肾单位的热缺血时间和出血,有利于该术式的开展。Objective：To describe our technique and results of laparoscopic partial nephrectomy（LPN）for centrally located renal tumors. Method：Between June 2006 and June 2011, we identified 8 patients who had undergone LPN for central tumors. To reduce the renal warm ischemia time and blood loss,cafeful isolation of renal vessels and selective control or ligation of 3rd order vessels feeding the tumors was perfomed for these patients. Result： Laparoscopic surgery was successful in all case without any open conversions,Six of them were done by retroperitoneai approach and 2 were done by tansperitoneal approach. The mean operating time and warm ischemia time was 220 minutes（range150 to 300）and 33 minutes（range 22 to 45） ,respectively. The mean tumor size was 2.8 cm （range 2.0 to 6.0） ,The pelvicaliceal system was entered and repaired in 6 patients（75.0 % ） ,and the median estimated blood loss was 130 ml（range 100 to 400）. None of them need intraoperative or postoperative transfusion. Histopathologic examination confirmed renal cell carcinoma in 6 patients（75.0 %）. The surgical margins and frozen sections of the tumor base were negative in all cases. ）. During a mean follow-up of 22. 3 months（range 3 to 46）, no patient had evidence of local recurrence or metastatic disease. Conclusion.. Laparoscopic partial nephrectomy for centrally located renal tumors is a feasible and safe procedure. Selective control or ligation of 3rd order renal vessels can reduce the renal warm ischemia time and blood loss.

关 键 词：肾肿瘤 肾部分切除术 腔镜术 

分 类 号：R737.11[医药卫生—肿瘤]