后腹腔镜肾肿瘤根治术治疗肾移植术后原肾恶性肿瘤2例报告并文献复习  

Retroperitoneoscopic radical nephrectomy in treatment of primary renal malignancies after kidney transplantation: 2 cases report and literature review

作　　者：芮桦 周伟民[1] 徐丹枫[2] 崔心刚[2] 

机构地区：[1]宜兴市人民医院,江苏宜兴214200 [2]第二军医大学附属长征医院

出　　处：《腹腔镜外科杂志》2013年第12期950-952,共3页Journal of Laparoscopic Surgery

摘　　要：目的:探讨后腹腔镜下肾肿瘤根治术在肾移植术后原肾恶性肿瘤患者中的临床应用价值,评估此术式在此罕见疾病中的有效性与安全性。方法:回顾分析2011年5月至2013年3月2例行肾移植术后原肾恶性肿瘤患者的临床资料,并结合文献进行分析。结果:2例手术均顺利完成,手术时间分别为44 min与52 min,术中出血量均小于30 ml,患侧肾上腺完整保留,术后分别随访24个月与3个月,影像学检查提示2例患者均未发生局部及远处转移。与术前相比,术后3个月患者肌酐及肾移植相关指标差异均无统计学意义;术后病理均为透明细胞癌,核分裂Ⅱ级。结论:后腹腔镜肾肿瘤根治术治疗肾移植术后原肾恶性肿瘤安全、有效,术中注意萎缩原肾的形态及肾蒂血管的解剖学改变是手术的关键。Objective：To study the clinical effects of retroperitoneoscopic radical nephrectomy in treatment of primary renal malignancies after kidney transplantation, and assess the surgical effectiveness and safety in this rare disease. Methods：Retrospective analysis was made on the clinical data of 2 patients who underwent renal transplantation from May 2011 to Mar. 2013 and corresponding literature. Patients were found primary renal masses after 36 and 44 months of donor renal transplantation, renal CT and MRI examinations showed the possibility of malignant tumors located in the primary kidney, the tumors were located in the middle and lower pole of ipsilateral kidney. The two patients underwent retroperitoneoscopie radical nephrectomy. Results： Two cases were completed successfully, operative time was 44 and 52 min, blood loss was less than 30 ml,patients＇ both ipsilateral adrenal glands were intact, postoperative follow-up time was 24 and 3 months,imaging studies suggested none of localized and distant metastasis occurred in the 2 patients. Compared with preoperative data, postoperative serum ereatinine and renal transplant related indicators were not statistically different 3 months after surgery, pathological results suggested clear cell carcinoma, mitotic class II. Condusions：Retroperitoneoseopic radical ne- phrectomy in the treatment of primary renal malignancies after kidney transplantation is safe and effective,intraoperative attention to the morphology of atrophy original kidney and vascular anatomical changes of the renal pedicle are the key of this surgery.

关 键 词：肾移植 肾肿瘤 肾肿瘤根治术 腹腔镜检查 腹膜后路径 

分 类 号：R737.11[医药卫生—肿瘤]