腹腔镜肾部分切除术治疗巨大囊实性肾占位(附5例报告)  

Laparoscopic partial nephrectomy for giant cystic solid renal masses: with a report of 5 cases

作　　者：宁定龙 蔡燚 王睿哲 童时宇[1] 陈敏丰[1] 齐琳[1] NING Ding-long;CAI Yi;WANG Rui-zhe(Department of Urology,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院,湖南长沙410008

出　　处：《腹腔镜外科杂志》2018年第8期581-584,共4页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹腔镜肾部分切除术治疗巨大囊实性肾占位的临床疗效及安全性。方法:回顾分析2018年4～7月为5例直径≥7 cm的巨大囊实性肾占位患者行腹腔镜肾部分切除术的临床资料,其中2例行经腹腹腔镜肾部分切除术,3例行经腹膜后肾部分切除术;男4例,女1例,平均(39.8±12.1)岁,肾占位最大径平均(7.6±0.7) cm,术前肌酐平均(88.6±16.9)μmol/L。分析手术时间、热缺血时间、术中出血量、切缘阳性率、住院时间、并发症情况及术后病理结果、肾功能恢复等情况。结果:5例均顺利完成腹腔镜肾部分切除术。手术时间平均(226±32) min,热缺血时间平均(41.6±8.8) min,术中出血量平均(256±227) mL,术后平均住院(6.6±0.8) d。术后第8天1例患者出现肾周血肿。病理结果示透明细胞癌3例、多房囊性肾瘤1例、肾结核肉芽肿性炎1例。术后1周血肌酐平均(99.6±18.9)μmol/L,与术前相比差异无统计学意义。结论:具备丰富手术经验的术者,腹腔镜肾部分切除术治疗巨大囊实性肾占位安全、可行,近期疗效显著,围手术期肾功能无明显变化。Objective ： To investigate the efficacy and safety of laparoseopie partial nephreetomy for giant cystic solid renal mas- ses.Methods：Retrospective analysis was made on the clinical data of 5 patients,who suffered fl＇om giant cystic solid renal masses with diameter more than 7 em and underwent laparoseopie partial nephreetomy from Apr.2018 to Jul.2018,ineluding 2 eases of transabdomi- nal laparoseopie partial nephreetomy and 3 eases of retroperitoneal partial nephreetomy.There were 4 males and 1 female with the mean age of （ 39.8± 12.1 ） years old, and the mean largest diameter of renal mass was （ 7.6± 0.7 ） cm, preoperative ereatinine was （ 88.6± 16.9） μmol/L.The operation time, warm isehemia time, intraoperative blood loss, positive margin rate, hospitalization time, complications,postoperative pathological results and renal function recovery were analyzed.Results：Laparoseopie partial nephreetomy was sue- eessfully performed in all 5 eases.The mean operation time was （226± 32）min, the mean warm isehemia time was （41.6±8.8）min, the mean intraoperative blood loss was （256±227）mL,the average postoperative hospital stay was （6.6±0.8）d.One patient had postopera- tive complication and perirenal hematoma occurred on the 8th day after surgery.Postoperative pathology included 3 eases of clear cell carcinoma, 1 ease of multiloeular cystic renal tumor,and 1 ease of renal tuberculosis granulomatous irdlammation.Serum ereatinine was （99.6± 18.9） μmol/L at 1 week after operation, and there was no significant difference compared with preoperative ereatinine.Conclusions：For experienced surgeons, laparoseopie partial nephreetomy is safe and feasible for the treatment of giant cystic solid renal masses.There is no significant change in renal function during perioperative period, the short-term efficacy is outstanding.

关 键 词：囊实性肾占位 肾部分切除术 腹腔镜检查 

分 类 号：R699.2[医药卫生—泌尿科学]