后腹腔镜下肾部分切除术治疗中度复杂性肾癌的方法改进及疗效分析(附84例报道)  

Efficacy of an improved method used in retroperitoneal laparoscopic partial nephrectomy for moderately complex renal carcinoma(Report of 84 Cases)

作　　者：刘溪[1] 潘秀武 杨启维[1] 李霖[1] 黄海[1] 吕建敏[1] 王林辉[1] 高轶[1] 徐丹枫[1] 崔心刚[2] 

机构地区：[1]第二军医大学附属长征医院泌尿外科,上海200003 [2]第二军医大学第三附属医院泌尿外科

出　　处：《临床泌尿外科杂志》2016年第6期533-537,共5页Journal of Clinical Urology

摘　　要：目的：比较分析后腹腔镜下肾部分切除术改进方法治疗中度复杂性肾癌的临床疗效及预后。方法：回顾性分析2012年9月～2014年9月R.E.N.A.L.评分为中度复杂肾癌（7～9分）并在我院行后腹腔镜下肾部分切除术的84例患者的临床资料,其中男56例,女28例,平均年龄（51.5±10.5）岁,肾脏肿瘤均为单发,其中腹侧12例,背侧72例,肿瘤直径（52±23）mm,R.E.N.A.L.平均评分为（8.1±0.92）分。结果：84例患者均顺利完成后腹腔镜下肾部分切除,其中采用＂2＋1＂法（改良组）48例,标准肾部分切步骤（对照组）手术36例,两组在平均手术时间[（104.2±31.6）min vs.（97.0±21.9）min）,P〉0.05]、术中出血量[（81.9±8.7）ml vs.（78.9±7.9）ml,P〉0.05）]、术后血清肌酐[（91±29）μmol/L vs.（93±42）μmol/L,P〉0.05）]、术后血红蛋白减少值[（2.2±1.8）g/ml vs.（1.9±1.3）g/ml,P〉0.05）]、术后住院天数[（6.0±2.0）d vs.（6.0±3.3）d,P〉0.05]等方面差异无统计学意义,但采用＂2＋1＂缝合法热缺血时间显著减少[（14.1±3.3）min vs.（17.6±4.9）min,P〈0.01）]。术后尿漏2例（改良组1例,对照组1例）;高热（体温〉39.0℃）两组各1例。术后平均随访（19.6±2.3）个月,所有患者未见肿瘤复发或转移,肾功能无持续恶化。结论：＂2＋1＂缝合法改良早期开放肾阻断钳技术及缝合方法,使热缺血时间显著缩短,扩大了肾部分切的适应证,保证患者术后生活质量,是一种安全高效的肾部分切手术方法,值得向临床推广。Objective：To evaluate the clinical efficacy and prognosis of an improved method used in retroperitoneal laparoscopic partial nephrectomy for moderately complex renal carcinoma according to R.E.N.A.L.nephrometry score.Method：A retrospective analysis of 84 patients treated with retroperitoneal laparoscopic partial nephrectomy from September 2012 to September 2014 in our hospital.There were 56 males and 28 females with mean age（51.5±10.5）years old.All cases were found a single tumor.Tumors of 12 cases located in the anterior and tumors of 72 cases located in the posterior.Mean tumor diameter was（52±23）mm.The average R.E.N.A.L.nephrometry score was（8.1±0.92）.Result：Retroperitoneal laparoscopic partial nephrectomy was successfully carried out in all cases.Forty-eight patients received ＂2＋1＂ method（improved group）,and 36 patients underwent standard partial nephrectomy procedure（control group）.There was no statistically significant difference between the improved group and control group in average operation time[（104.2±31.6）min vs.（97.0±21.9）min,P〈0.05],mean intraoperative blood loss[（81.9±8.7）ml vs.（78.9±7.9）ml,P〈0.05）],postoperative serum creatinine[（91±29）μmol/L vs.（93±42）μmol/L,P〈0.05）],postoperative hemoglobin reduction[（2.2±1.8）g/ml vs.（1.9±1.3）g/ml,P〈0.05）],postoperative hospital stay [（6.0±2.0）d vs.（6.0±3.3）d,P〈0.05].However,the ischemia time was significantly shorter in the improved group[（14.1±3.3）min vs.（17.6±4.9）min,P〈0.01）].Postoperative urinary leakage was found in one case in each group.Also,high fever（39.0℃）was found in one case in each group.All patients were followed up for（19.6±2.3）months,and no metastasis,recurrence or continuous deterioration of renal function was found.Conclusion：An improved method of ＂2＋1＂ modified early unclamping technique and the way of suturing,which can significantly shorten the warm ischemia time,expand the indication of the retroperitoneal

关 键 词：肾癌 后腹腔镜检查 肾部分切除术 早期松开肾动脉阻断钳 缝合方法 

分 类 号：R737.11[医药卫生—肿瘤]