3D后腹腔镜保留肾单位手术治疗T1b期肾癌的临床研究  

A Clinical Study of 3D Retroperitoneal Laparoscopic Nephron Sparing Surgery for the Treatment of Stage T1b Renal Cell Carcinoma

作　　者：程涛 双卫兵[2] 关超[1] 方文革[1] 叶大文 王文湛[3] 杨浩森 CHENG Tao;SHUANG Wei-bing;GUAN Chao;FANG Wen-ge;YE Da-wen;WANG Wen-zhan;YANG Hao-sen(Department of Urology,Second Hospital Affiliated to Bengbu Medical College,Bengbu,Anhui,233000,China;Department of Urology,The First Hospital of Shanxi Medical University,Taiyuan,Shanxi,030001,China;The First Clinical Medical College of Shanxi Medical University,Taiyuan,Shanxi,030001,China)

机构地区：[1]蚌埠医学院第二附属医院泌尿外科,安徽蚌埠233000 [2]山西医科大学第一医院泌尿外科,山西太原030001 [3]山西医科大学第一临床医学院,山西太原030001

出　　处：《泌尿外科杂志（电子版）》2019年第3期17-21,共5页Journal of Urology for Clinicians(Electronic Version)

基　　金：蚌埠医学院自然科学基金重点项目(NO.BYKY1749ZD)资助

摘　　要：目的探讨3D后腹腔镜保留肾单位手术(nephron sparing surgery,NSS)治疗T1b期肾癌的安全性及有效性。方法回顾性分析自2015年1月至2018年12月作者单位收治的53例行3D后腹腔镜保留肾单位手术的T1b期肾癌患者的临床资料。结果53例患者均顺利完成NSS,无中转开放手术。手术时间70~220分钟,平均(142.6±45.1)分钟。热缺血时间14~35分钟,平均(24.2±6.6)分钟。术中出血量50~300ml,平均(104.2±48.6)ml。所有患者术中均未输血。术后1天血肌酐56~141μmol/L,平均(85.1±21.3)μmol/L。术后住院4~11天,平均(5.9±1.8)天。3例患者因肿瘤贴近集合系统,术后出现尿漏,予以留置双J管,随访未出现尿漏。术后病理提示:透明细胞癌44例,乳头状癌3例,嫌色细胞癌6例。术后随访3~42个月,平均(27.3±21.5)个月。术后1个月血肌酐39~135μmol/L,平均(67.4±18.1)μmol/L;术后3个月血肌酐45~129μmol/L,平均(70.3±15.2)μmol/L;术后6个月血肌酐41~137μmol/L,平均(68.1±19.1)μmol/L。术后1天血肌酐较术前明显升高,差异有统计学意义(P<0.01)。术后1个月、3个月、6个月血肌酐较术后1天明显下降,差异有统计学意义(P<0.01)。术后1个月、3个月、6个月之间血肌酐值比较,差异无统计学意义(P>0.05)。53例患者术后随访未发现肿瘤局部复发及远处转移。结论3D后腹腔镜保留肾单位手术治疗T1b期肾癌,创伤小、恢复快、安全有效,最大限度切除肿瘤的同时,能很好的保留余肾的功能,兼具安全性及有效性。Objective To study the safety and efficacy of 3D retroperitoneal laparoscopic nephron-sparing surgery for the treatment of stage T1b renal cell carcinoma(RCC).Methods A retrospective study was conducted,based on the clinical data of 53 patients with stage T1b RCC treated with 3D retroperitoneoscopic laparoscopic nephron sparing surgery from January 2015 to December 2018.Results All the operations were accomplished successfully without conversion to open surgery.The operation time ranged from 70 to 220 minutes[mean(142.6±45.1)minutes].The warm ischemia time was from 14 to 35 minutes[mean(24.2±6.6)minutes].The volume of intraoperative bleeding ranged from 50 to 300ml[mean(104.2±48.6)ml].No patient received intraoperative blood transfusion.The level of serum creatinine ranged from 56 to 141μmol/L at 1 day after surgery[mean(85.1±21.3)μmol/L].The postoperative hospital stay was from 4 to 11 days[mean(5.9±1.8)days].Urinary leakage happened in 3 patients postoperatively,double J tube was indwered and no urinary leakage was found during follow-up.In the postoperative pathological findings,there were 44 cases of clear cell carcinoma,3 cases of papillary carcinoma and 6 cases of chromophobe carcinoma.The postoperative follow-up ranged from 3 to 42 months,with an average of(27.3±21.5)months.The level of serum creatinine was 39 to 135μmol/L at 1 month after surgery[mean(67.4±18.1)μmol/L].The level of serum creatinine was from 45 to 129μmol/L at 3 months after surgery[mean(70.3±15.2)μmol/L].The level of serum creatinine ranged from 41 to 137μmol/L at 6 months after surgery[mean(68.1±19.1)μmol/L].The level of serum creatinine at day 1 after surgery was significantly higher than that of the preoperative one(P<0.01).The level of serum creatinine at 1 month,3 months and 6 months after surgery was significantly lower than the serum creatinine at day 1 postopertively(P<0.01).There was no significant difference in serum creatinine between 1 month,3 months and 6 months after surgery(P>0.05).No tumo

关 键 词：腹腔镜 保留肾单位手术 肾癌 

分 类 号：R73[医药卫生—肿瘤]