无“蓝蝶”装置行手助腹腔镜肾部分切除术治疗T1b期肾肿瘤经验总结  

Hand Assisted Laparoscopic Partial Nephrectomy for Treatment of T1b Renal Cell Carcinoma

作　　者：赵国斌[1] 李向东[1] 凌海滨[1] 孔雁萍[1] 唐玉红[2] 张秀梅 苏宏伟[1] 张潮[1] 

机构地区：[1]河北北方学院附属第一医院泌尿外科,河北张家口075000 [2]河北北方学院检验学院,河北张家口075000 [3]张家口市沙岭子医院急诊科,河北张家口075000

出　　处：《临床误诊误治》2015年第4期91-93,共3页Clinical Misdiagnosis & Mistherapy

基　　金：河北省医学科学研究重点课题计划指令项目(ZL20140296);张家口市科学技术与发展指导计划项目(1321124D)

摘　　要：目的探讨不使用"蓝蝶"装置行手助腹腔镜肾部分切除术治疗T1b期肾肿瘤的方法及临床效果。方法2011年2月—2013年2月住院的T1b期肾癌15例,在不使用"蓝蝶"装置的情况下,行手助腹腔镜肾部分切除术,根据术者手掌直径做皮肤切口,在手进入后腹腔后辅助操作,用布巾钳钳夹切口两侧防止漏气。结果所有手术均顺利完成,平均手术时间(120.5±25.6)min,术中平均热缺血时间(25.2±7.4)min,术中平均出血量(48.3±10.2)ml,平均手术切口长度(6.5±0.6)cm,术后平均住院时间(9.2±2.4)d;术后尿漏1例,予输尿管支架管治疗后痊愈,围术期无严重并发症。术后平均随访(16.4±11.2)个月,所有患者肾功能均正常且未见肿瘤复发及转移。结论不使用"蓝蝶"装置行手助腹腔镜肾部分切除术治疗T1b期肾肿瘤安全、有效,学习曲线短,但远期疗效尚需大样本对照研究和长期随访观察。Objective To investigate operational methods and clinical effect of hand-assisted laparoscopic without ＂ Lapdisc＂ partial nephrectomy for treatment of T1 b renal cell carcinoma. Methods 15 patients with T1 b renal cell carcinoma admitted during Feb 2011 and Feb 2013 were retrospectively analyzed,according to the diameter of the palm for skin incision,after the hand was put into abdominal cavity for auxiliary operations and towel forceps clamps were used to prevent leakage,and hand assisted laparoscopic partial nephrectomy without ＂ Lapdisc＂ was performed. Results All the 15 cases were operated upon successfully without conversion to open surgery,and there were no severe complications in the perioperative period. The mean operation time was（ 120. 5 ± 25. 6） min,mean warm ischemia time was（ 25. 2 ± 7. 4） min,the average amount of bleeding during operation was（ 48. 3 ± 10. 2） ml,mean incision length was（ 6. 5 ± 0. 6） cm and mean postoperative hospital stay was（ 9. 2 ±2. 4） d. Postoperative urinary leakage was found in one case and was successfully treated with placement of a double J tube. All the patients had normal renal function and had no tumor recurrence or metastasis during a mean follow-up of（ 16. 4 ±11. 2） months. Conclusion Hand assisted laparoscopic partial nephrectomy without ＂ Lapdisc＂ is safe and effective for treatment of patients with T1 b renal cell carcinoma. But the long-term effect still needs more sample research and a long-term followup study.

关 键 词：手助腹腔镜检查 肾切除术 肾肿瘤 

分 类 号：R737.11[医药卫生—肿瘤]