后腹腔镜下分支肾动脉序贯阻断肾部分切除术在多发肾肿瘤患者中的应用  

Application of retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping for patients with multiple renal tumors

作　　者：秦超[1] 邵鹏飞[1] 王增军[1] 李普[1] 杨杰[1] 薛建新[1] 夏佳东[1] 李杰[1] 吕强[1] 殷长军[1] Qin Chao Shao Pengfei Wang Zengjun Li Pu Yang Jie Xue Jianxin Xia Jiadong Li Jie Lv Qiang Yin Changjun(Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanfing 210029, China)

机构地区：[1]南京医科大学第一附属医院泌尿外科,210029

出　　处：《中华泌尿外科杂志》2017年第2期81-83,共3页Chinese Journal of Urology

摘　　要：目的 探讨孤立肾或对侧肾功能不全的多发肾肿瘤患者行后腹腔镜下分支肾动脉序贯阻断肾部分切除术的可行性和安全性.方法 回顾性分析2011年10月至2016年10月我们收治的7例行后腹腔镜下分支肾动脉序贯阻断肾部分切除术的肾癌患者的临床资料.男3例,女4例.年龄37～65岁,平均51岁.肿瘤位于左肾5例,右肾2例.6例患侧肾脏2枚肿瘤,1例3枚肿瘤;肿瘤直径1.8～3.5 cm,平均2.5 cm,均为外生型生长;R.E.N.A.L评分4～6分,平均4.4分.分析术中、术后各项指标,包括手术时间、分支肾动脉阻断时间、术中出血量、术后住院时间、围手术期并发症及术后肾功能等.结果 7例患者共切除15枚肿瘤,均顺利完成手术.手术时间100～ 180 min,平均125 min;分支肾动脉阻断时间10 ～ 30 min,平均23 min;术中出血量120～330 ml,平均190 ml;术后住院时间3 ～6d,平均5d.围手术期无并发症发生.术后病理诊断：肾透明细胞癌4例,乳头状癌1例,血管周上皮样细胞肿瘤2例;切缘均阴性.术后随访3 ～ 60个月,所有患者均未见肿瘤复发、转移,术后3个月复查肌酐102～187 μmol/L.结论 对于孤立肾或对侧肾功能不全的多发肾肿瘤患者,后腹腔镜下分支肾动脉序贯阻断肾部分切除术安全可行,可最大限度地减少对肾脏的热缺血损伤并有效保护肾功能.Objective To explore the feasibility and safety of retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping for the patients with multiple renal tumors and solitary kidney or contralateral kidney insufficiency.Methods Seven patients who have undergone retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping between October 2010 and October 2016 were retrospectively analyzed,and clinical materials and parameters during and after the operation were summarized,including operation time,clamping time of segmental renal artery,blood loss during the operation,complications and renal function after the operation.Results Fifteen tumors were resected in 7 patients and the operations were all successful.The operation time ranged from 100 to 180 minutes with the average of 125 minutes;clamping time of segmental renal artery was 10-30 minutes with the average of 23 minutes;the amount of blood loss during the operation was 120-330 ml with the average of 190 ml;hospital stay after the operation is 3-6 d with the average of 5 d.There was no complication during the perioperative period,and the pathology diagnosis after the surgery showed that there were 4 renal clear cell carcinomas,1 papillary carcinoma and 2 perivascular epithelioid cell tumors and the margins were all negative.All patients were followed up for 3-60 months,and no local recurrence or metastasis was detected,and the creatinine was 102-187 μmol/L at 3 months after operation.Conclusions For the patients with multiple renal tumors and solitary kidney or contralateral kidney insufficiency,retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping was feasible and safe,which minimized the hot ischemia injury to the kidney and preserved the renal function effectively.

关 键 词：肾肿瘤 后腹腔镜手术 肾部分切除术 分支肾动脉 序贯阻断 

分 类 号：R737.11[医药卫生—肿瘤]