小切口开放式保留肾单位手术治疗中山评分≥8分肾肿瘤的临床研究  

Mini-flank incision for open partial nephrectomy for renal tumor with Zhongshan score≥8

作　　者：王杭[1] 周林[1] 卞亭长 杨念钦[1] 陈伟[1] 姜帅[1] 朱延军[1] 郭剑明[1] 

机构地区：[1]复旦大学附属中山医院泌尿外科,上海200032

出　　处：《中华泌尿外科杂志》2015年第10期732-735,共4页Chinese Journal of Urology

摘　　要：目的：探讨小切口开放式保留肾单位手术（nephronsparingsurgery，NSS）治疗中山评分≥8分肾肿瘤的可行性及疗效。方法回顾性分析2012年1月至2014年12月收治的25例肾肿瘤患者的资料，男18例，女7例。年龄26～75岁，平均50．2岁。体质指数21．3～30．1kg／m2，平均24．5kg／m2。体检发现肾肿瘤17例，因血尿就诊6例，因其他疾病就诊2例。15例患肾对侧尿路有结石、肾囊肿或肾积水等良性病变，4例为双侧肾癌。术前血肌酐为47～132μmol／L，平均76．9μmol／L。eGFR36．5～173．9ml／（min·1．73m2），平均103．8ml／（min·1．73m2）。中山评分8分11例，9分3例，10分5例，11、12、13分各2例。CT检查示肿瘤最大径2．5～8．1cm，平均4．9cm。全麻下行小切口NSS，切口长7．5～10．0cm，平均8．0cm。切开腰部肌肉暴露Gerota筋膜，打开筋膜后根据术前CT检查结果确定肿瘤位置，暴露肿瘤及其周围2～3cm的正常肾组织。沿肾背侧分离至肾门，锐性＋钝性分离出肾动脉，以动脉夹阻断动脉。沿肿瘤边缘0．5～1．0cm正常肾组织完整切除肿瘤。创面内可见的血管断端均以3-0可吸收线行“8”字缝合，再以2-0可吸收线“U”或“8”字形贯穿缝合创面，最后放开动脉夹。记录手术时间、术中热缺血时间、估计出血量以及术中、术后并发症和术后短期（2～3个月）肾功能情况。结果本组25例中，23例完成NSS手术；1例因肿瘤累及肾盂和肾盂输尿管连接处，改行根治性肾切除术；1例因切除的肿瘤标本基底部包膜不完整，考虑有切缘阳性可能，改行根治性肾切除术。手术时间75～150min，平均100．2min。术中热缺血时间21～39min，平均28．3min。术中出血量10～400ml，平均63．6ml，1例输血治疗。术后发生1例手术区域局部积液，经穿刺引流后好转。未发生其他手术相关并发症。住院时间5～9d，平均6．6d。病�Objective To evaluate the effect and feasibility of mini-flank approach for open partial nephrectomy （MI-OPN） in complex renal tumors with high Zhongshan Score （ZS Score ≥8）.Methods Between January 2012 and December 2014, the data from 25 patients with renal tumors , including 18 male and 7 female patients, were retrospectively reviewed.The average age was 50.2 years（range 26-75 years） and the average body mass index was 24.5 kg/m2（range 21.3-30.1 kg/m2）.The initial symptom included asymptom in 17 cases, hematuria in 6 cases and other presentation in 2 cases.Bilateral renal tumors were found in 4 cases.Fifteen cases suffered with contralateral urinary stone , renal cyst or hydronephrosis .The preoperative serum creatinine level was 76.9 μmol/L （ range 47 -132 μmol/L ） and the preoperative estimated glomerular filtration rate （eGFR） was 103.8 ml/（min· 1.73 m2）（range 36.5-173.9）.The ZS Score was 8 in 11 cases, 9 in 3 cases, 10 in 5 cases, 11 in 2 cases, 12 in 2 cases, and 13 in 2 cases.Mean maximum tumor size was 4.9 cm （ range 2.5-8.1 cm） in CT scan.The average length of incision was 8.0 cm（ 7.5 -10.0 cm ） .During the operation , the mass and around normal renal tissue were exposed after opening the Gerota fascia.Along the dorsal of kidney , the renal artery was dissected and clamped .Then, the mass was completely removed along margin of 0.5-1.0 cm normal renal tissue.The vascular end was closed by 3-0 absorbable suture.The entire wound of kidney was U shaped closed by 2-0 absorbable suture.The operative time, ischemia time, estimate blood loss, pathology parameters, operative and short-term （2 -3 months） postoperative complications were recorded .Renal function was recorded 2 -3 months after operation.Results MI-OPN was successfully performed in 23 cases.Radical nephrectomy was performed in 1 cases due to the tumor invasion into the renal pelvis and ureteropelvic junction .Another radical nephrectomy was performed for suspection of positive margin .Mean operative t

关 键 词：肾肿瘤 保留肾单位手术 小切口 中山评分 

分 类 号：R737.11[医药卫生—肿瘤]