零缺血小切口肿瘤剜除术在T1b期肾癌中的手术技巧和应用体会  

Zero ischemia mini-flank incision for simple enucleation for T1b renal cell carcinoma

作　　者：邢庆菲 李常颖[1] 王一[1] 李建民[1] 王滨帅[1] 孙光[1] 郭战军[1] 

机构地区：[1]天津医科大学第二医院泌尿外科,天津市泌尿外科研究所天津市泌尿外科基础医学重点实验室,天津300211

出　　处：《现代泌尿外科杂志》2016年第5期372-375,共4页Journal of Modern Urology

摘　　要：目的探讨零缺血小切口肿瘤剜除术治疗T1b期肾癌的手术技巧及临床应用效果。方法回顾性分析46例分别采用小切口方式（分为阻断肾蒂与不阻断肾蒂）、传统开放（分为阻断肾蒂与不阻断肾蒂）和腹腔镜方式（均阻断肾蒂）治疗T1b期肾癌的临床效果。结果小切口组在术中出血量、手术时间、术后恢复方面均较其他两种术式有显著优势（P〈0.01）;小切口组内阻断肾蒂与未阻断肾蒂相比,术前、术后6个月肾小球滤过率（GFR）变化量分别为（5.1±1.7）mL/min和（1.1±0.8）mL/min,差异有统计学意义（P=0.008）。术后随访24～108个月,3组肿瘤局部复发差异无统计学意义（χ^2=0.46,P=1.0）。结论在T1b期肾癌的治疗中,零缺血小切口肿瘤剜除术在有效的切除肾脏肿瘤的基础上,能够最大限度地保护肾功能,减少手术创伤。Objective To evaluate the feasibility and clinical efficacy of zero ischemia mini-flank for simple enucleation for T1b renal cell carcinoma.Methods The clinical data of 46 cases of cT1b renal masses treated with mini-flank（n=17）,traditional operation（n=18）and laparoscopic surgery（n=11）were retrospectively reviewed.Results The mini-flank approach had more advantages than the other two approaches in the average operation time,intraoperative blood loss,and recovery of bowel function（P〈0.01）.Within the mini-flank group,there was significant difference between those with hilar clamping[GFR=（5.1±1.7）mL/min]and without hilar clamping[GFR=（1.1±0.8）mL/min]（P=0.008）.During the follow-up of 8 to 60 months,there was no difference in the recurrence rate among the three groups（χ^2=0.46,P=1.0）.ConclusionZero ischemia mini-flank for simple enucleation for T1b renal cell carcinoma can remove the specimen with a small incision and protect the function of kidney.

关 键 词：保留肾单位手术 零缺血 小切口 肾癌 

分 类 号：R737[医药卫生—肿瘤]