国内首例经脐单孔腹腔镜肾肿瘤冷冻消融术  

Transumbilical laparo-endoscopic single-site (LESS) renal cryoablation: The first clinical case in China

作　　者：徐斌[1] 王林辉[1] 刘冰[1] 宋尚卿[1] 肖亮[1] 吴震杰[1] 侯炯[2] 程欣[1] 盛夏[1] 孙颖浩[1] 

机构地区：[1]第二军医大学长海医院泌尿外科,上海200433 [2]第二军医大学长海医院麻醉科,上海200433

出　　处：《中华腔镜泌尿外科杂志（电子版）》2013年第2期17-20,共4页Chinese Journal of Endourology(Electronic Edition)

基　　金：上海市市级医院新兴前沿技术联合攻关项目(SHDC12010115);军队临床高新技术重大项目(2010gxjs057);上海市重点学科项目

摘　　要：目的完善相关术前评估并取得患者知情同意后,完成国内首例经脐单孔腹腔镜下肾肿瘤冷冻消融术,并探讨该手术的可行性和安全性,总结操作经验,评价手术疗效。方法 2012年9月15日我科顺利完成经脐单孔多通道(TriPortTM)腹腔镜下肾癌冷冻消融术1例。患者59岁男性,BMI24.5kg/m2,肿瘤位于左肾,最大径2.1cm,术前血肌酐及左右侧GFR分别为:100μmol/L、37.2ml/min和34ml/min。于脐上缘取一2cm半弧形皮肤切口,充分游离暴露肿瘤表面,腹腔镜监视下将1把2mm直角冷刀经皮穿刺后置入瘤体内,按照EndoCare冷刀手术操作系统完成两个循环后退出冷冻刀头。结果手术顺利完成,手术时间、冷冻时间、术中出血分别为:120min、30min和30ml。术后前3d患者视觉疼痛模拟评分分别为:1、1和0分。术后住院时间5d,无任何手术相关并发症。术后病理组织学评估为透明细胞癌,Furhman分级为Ⅱ级。术后4周复查血肌酐及左右侧GFR分别为:97μmol/L、36.1ml/min和34.8ml/min。术后1周、4周复查肾脏增强CT提示局部完全失去对比剂增强,肿瘤已完全消退,无局部复发。结论初步经验表明经脐单孔腹腔镜下肾肿瘤冷冻消融术安全、可行,术后患者疼痛轻、恢复快、切口小、肾功能损害小、肿瘤治疗近期疗效确切。但其远期疗效有待前瞻性大样本的长期随访对照研究。Objective To present the first clinical case of transumbilieal laparoendoscopic single-site （LESS） renal cryoablation in the mainland of China and assess its safety and feasibility. Methods One patient with an enehancing radiographic small renal mass underwent transumbilieal laparoendoscopic single-site renal eryoablation on 15-Sep-2012 in our institution. The salient patient demographics and tumor characteristics, including age, gender, body mass index, tumor laterality, diameter （cm）, and preoperative lett and right GFR were： 59 years, male, 24.5 kg/m2, left, 2.1 cm, 37.2 ml/min and 34 ml/min. A 2 cm longitudinal transumbilieal skin incision was made. With the renal mass fully dissected and exposed, a 2 mm cryoprobe was introduced percutaneously and placed into the tumor under laparoscopic visualization. Two freeze-thaw eryoablation cycles were performed according to the instructions of EndoCare Cryo-Care Surgery System. Results The procedure was smoothly completed without any extraskin incision. Operation time, cyroablation time and estimated blood loss was 120 rain, 30 min and 30 ml respectively. Postoperative pain measured by the visual analog pain scale （VAPS） at day1, day2 and day3 was 1, 1 and 0 respectively. The patient was discharged 5 days after surgery. Pathologic examination revealed renal clear cell carcinoma with Fuhrman grade II . The left and right GFR tested at 4-week follow-up was 36.1 ml/min and 34.8 ml/min respectively. No evidence of contrast-enhancing at the cyroablative region by contrasted renal CT scan performed 1 week and 4 weeks after surgery was observed, indicating no tumor remnant or recurrence. Conclusions The initial experience shows the transumbilical laparoendoseopic single-site renal cryoablation is a safe, feasible and effective procedure. It may exhibit clinical benefits for patients in terms of pain control, preservation of renal function, convalescence and cosmesis.

关 键 词：经脐 单孔腹腔镜 冷冻消融 

分 类 号：R737.11[医药卫生—肿瘤]