后腹腔镜辅助经腰小切口肾部分切除术治疗复杂性T_1期肾癌(附28例报告)  

Retroperitoneal laparoscope-assisted small incision partial nephrectomy for complex T1renal cell carcinomas:a report of 28 cases

作　　者：李鹏[1,2] 杨庆[1] 纪家涛[1] 肖成武[1] 刘冰[3] 叶华茂[1] 徐斌[1] 王林辉[3] 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]解放军153中心医院泌尿外科,郑州450042 [3]第二军医大学长征医院泌尿外科,上海200003

出　　处：《第二军医大学学报》2015年第1期90-94,共5页Academic Journal of Second Military Medical University

摘　　要：目的探讨后腹腔镜辅助经腰小切口肾部分切除术治疗复杂性T1期肾癌的可行性及其疗效。方法回顾分析2010年7月至2013年12月间我科收治的28例复杂性T1期肾癌患者的临床资料,肿瘤直径(3.76±1.28)cm,其中内生性肾癌13例,T1b期肾癌12例,近肾门肾癌7例,解剖性孤立肾肾癌2例,肾肿瘤解剖学特征PADUA评分为(9.07±1.25)分。所有患者均接受后腹腔镜辅助经腰小切口肾部分切除术治疗。结果 28例患者均顺利完成手术,围手术期无尿漏、大出血等严重并发症,手术时间(213.82±40.04)min,术中肾脏冷缺血时间(23.88±5.98)min,手术出血量(191.07±94.33)mL,手术切口长度(9.48±1.56)cm,患者术后疼痛评分(1.11±0.31)分,2例患者术后出现短暂性高热,经对症处理后体温恢复正常。患者术后平均住院(11.54±3.98)d,均正常出院。术后随访(21.46±12.15)个月,术后第1个月患侧肾脏肾小球滤过率(GFR)平均下降(21.71±11.48)%,随访期间均未发现肿瘤局部复发或远处转移。结论后腹腔镜辅助经腰小切口肾部分切除术治疗体积较大、内生性生长或靠近肾门的复杂性T1期肾癌疗效满意,技术上安全、可行,便于实施和掌握,其手术切口创伤较小,值得临床推广应用,其远期疗效尚需大样本随机对照研究和长期随访观察。Objective To assess the feasibility and outcomes of retroperitoneal laparoscope-assisted small incision partial nephrectomy for patients with complex T1 renal cell carcinomas （RCCs）. Methods The clinical data of twenty-eight patients with complex T1 RCCs, who underwent retroperitoneal laparoscope-assisted small incision partial nephrectomy at our institution between Jul. 2010 and Dec. 2013, were retrospectively analyzed. The tumor diameter was （3.76±1.28） cm and the PADUA score was 9.07±1.25 in this group. There were 13 patients with endophytic tumors, 12 at Tab stage, 7 reniportal RCCs, and 2 cases of solitary kidney. Results All the patients successfully underwent operations, with no severe postoperative complications such as leakage of urine or massive hemorrhage. The operative time was （213.8±40.04） min, the renal cold ischemic time was （23.86±5.98） min, the estimated blood loss was （191.07±94.33） mL, the skin incision length was （9.48±1.56） cm, and the postoperative pain score was （1.11 ± 0.31）. Two patients developed transient hyperpyrexia postoperatively and were successfully managed with expectant treatment. And all the patients were discharged safely after a hospital stay of （11.54 ±3.98） days after surgery. The patients were followed up for （21.46± 12. 15） months. At the 1^st month postoperation, the glomerular filtration rate （GFR） deceased by an average of （21.71 ± l 1.48）%. No recurrence or metastasis occurred during the follow-up. Conclusion Retroperitoneal laparoscope-assisted small incision partial nephrectomy is a safe, feasible method for complex T1 RCCs, especially for the larger, endophytic, and reniportal tumors. The method is easy to learn and has small incision, but the long term effect needs to be observed by large sample randomized studies.

关 键 词：肾肿瘤 腹腔镜手术 小切口 肾部分切除术 

分 类 号：R737.11[医药卫生—肿瘤]