后腹腔镜肾部分切除术个体化方案在小肾癌治疗中的应用  

Application of laparoscopic partial nephrectomy with individual operation plan in treatment of small renal cell carcinoma

作　　者：邵四海[1] 汤建儿[1] 沈悦凡[1] 向安平[1] 王伟高[1] 王荣江[1] Si-hai Shao;Jian-er Tang;Yue-fan Shen;An-ping Xiang;Wei-gao Wang;Rong-jiang Wang(Department of Urology, the First People’s Hospital of Huzhou, the First Afiliated Hospital of Huzhou University, Huzhou, Zhejiang 313000, China)

机构地区：[1]浙江省湖州市第一人民医院(湖州师范学院附属第一医院)泌尿外科,浙江湖州313000

出　　处：《中国内镜杂志》2017年第8期105-110,共6页China Journal of Endoscopy

摘　　要：目的探讨后腹腔镜下肾部分切除术(RLPN)个体化方案治疗小肾癌的可行性、安全性。方法回顾性分析2012年6月-2016年6月收治的98例实行RLPN治疗的小肾癌患者,男57例,女41例,年龄28~75岁,平均52岁,肿瘤位于左肾46例,右肾52例,直径0.8~4.5 cm,平均3.1 cm。87例(A组)小肾癌采用标准阻断肾动脉的状态下实施肾部分切除;7例(B组)外突性生长的小肾癌采用术中游离肾动脉,套橡皮条备用,试行不阻断肾动脉零缺血的状态下实施肾部分切除;4例(C组)影像学检查提示内生性小肾癌,采用腔内超声术中精确探查定位肾动脉阻断下实施肾部分切除。从术中情况、术后随访结果等分析其可行性、安全性。结果 A组87例中2例转开放手术,1例切缘阳性,改腹腔镜下肾根治性切除术,术中出血量30~350 ml,平均93 ml,手术时间70~245 min,平均127 min,术中热缺血时间20~42 min,平均26 min。B组7例外突性生长的肾癌,6例未阻断肾动脉,1例出血明显,切除肿瘤过程中,再阻断肾动脉15 min,完成肾部分切除术,出血量160~380 ml,平均220 ml,手术时间85~215 min,平均143 min。C组4例中内生性小肾癌全部手术过程顺利,出血量35~250 ml,平均85 ml,手术时间110~235 min,平均175 min,术中热缺血时间25~40 min,平均28 min。随访6~48个月,中位时间26个月,1例(肾门处3.0 cm透明细胞癌)术后18个月发现局部复发及肺部转移,予索拉非尼分子靶向治疗。结论 RLPN个体化方案治疗小肾癌安全、有效,但尚需增加例数和长期随访观察明确其远期疗效。Objective To evaluate the feasibility and clinical efficacy of retroperitoneal laparoscopic partialnephrectomy(RLPN)with individual operation plan in treatment of small renal cell carcinoma(RCC).Methods98patients with small RCC who was treated by RLPN from June2012to June2016were retrospectively analyzed.There were57males and41females with a mean age of52years old(ranging28~75years old).52cases werelocated on the right side while46cases were left.The mean tumor size was3.1cm in diameter(ranging0.8~4.5cm).87patients(A group)were underwent standard RLPN with clamping main renal artery.7patients(B group)withexophytic RCC were performed without clamping renal artery,but with separating main renal artery and preparedfor possible clamping.4patients(C group)with endophytic RCC were performed with clamping renal artery under ultrosound monitoring.The feasibility and outcomes were evaluated by surgical and oncological outcomes.Results84cases among A group were underwent standard RLPN successfully,with2cases converted to open surgery and1case failed to excising tumor completely and converted to laparoscopic radical nephrectomy.The amount of bleedingduring operation was30~350ml,average93ml,operation time was70~245min,average127min,warm ischemiatime20~42min,average26min.6cases among B group were performed successfully without clamping renalartery with1case converted to clamp renal artery for15min during the operation because of obvious bleeding.Theamount of bleeding was160~380ml,average220ml,operation time was85~215min,average143min.4casesof C group were all performed successfully,The amount of bleeding was35~250ml,average85ml,operation timewas110~235min,average175min,warm ischemia time25~40min,average28min.With a mean follow up of28months(ranging18~42months),there was only1case of A group occured local recurrence and lung metastases andaccepted molecular targeted therapy with Sorafenib.Conclusion RLPN with individual operation plan in treatmentof small RCC is safe and effective,the long-term effect of the procedure needs fu

关 键 词：腹腔镜 肾部分切除术 肾肿瘤 

分 类 号：R737.11[医药卫生—肿瘤]