腹腔镜辅助小切口“零缺血”巨大肾血管平滑肌脂肪瘤切除术9例报告  

Laparoscopic-assisted small-incision zero-ischemia partial nephrectomy for huge renal angiomyolipoma:report of 9 cases

作　　者：徐刚[1] 张国玺[1] 邹晓峰[1] 袁源湖[1] 肖日海[1] 伍耿青[1] 钱彪 王晓宁[1] 徐辉[1] 刘佛林[1] 刘全亮[1] 谢天朋[1] 何志华 江波[1] 邹毓华[1] 张兆林[1] 曾庆明[1] 刘林伟[1] XU Gang;ZHANG Guoxi;ZOU Xiaofeng;YUAN Yuanhu;XIAO Rihai;WU Gengqing;QIAN Biao;WANG Xiaoning;XU Hui;LIU Folin;LIU Quanliang;XIE Tianpeng;HE Zhihua;JIANG Bo;ZOU Yuhua;ZHANG Zhaolin;ZENG Qingming;LIU Linwei(Department of Urology,First Affiliated Hospital of Gannan Medical University,Jiangxi EngineeringResearch Center for Stone Prevention and Control,Ganzhou,Jiangxi,341000,China)

机构地区：[1]赣南医学院第一附属医院泌尿外科江西省结石防治工程技术研究中心,江西赣州341000

出　　处：《临床泌尿外科杂志》2020年第5期354-357,共4页Journal of Clinical Urology

基　　金：江西省科技厅科技计划项目(No:20151BBG70070)。

摘　　要：目的:总结腹腔镜辅助小切口“零缺血”巨大肾血管平滑肌脂肪瘤(renal angiomyolipoma,RAML)切除术的经验与体会,探讨其安全性和可行性。方法:回顾性分析2015年7月~2019年10月我院施行的9例腹腔镜辅助小切口“零缺血”巨大RAML切除术患者的临床资料。男4例,女5例;中位年龄43.7(36~78)岁;中位BMI 24.6(19.5~32.9)kg/m^2;右肾3例,左肾6例;中位肿瘤最大径10.5(8.5~15.0)cm。其中1例合并胃间质瘤(直径2.0cm)。全麻。健侧70°卧位,于患侧脐缘置入一trocar,插入腹腔镜,于患侧肋缘下沿腹直肌旁分别置入2个trocar,间距约10cm,插入操作器械。先在腹腔镜下游离肾脏及肾蒂,肿瘤周围暂不作游离。再取患侧腹直肌旁两trocar间小切口,必要时适当延长。直视下游离肾脏与肿瘤交界处,并用手指挤压正常肾实质,不阻断肾动脉,切除肿瘤并缝合创面,再将肿瘤周围游离后完整取出。合并胃间质瘤者,同期腹腔镜下一并处理。结果:本组9例手术均顺利完成。中位手术时间150(120~210)min,术中中位失血量220(150~350)mL,中位体表切口长径11.2(10.0~13.5)cm。均未输血,术中、术后均未发生严重并发症。所有患者术后恢复顺利,切口愈合良好。术后复查肾功能与术前无显著变化。术后中位视觉模拟疼痛评分(VAS)2(1~3)分,术后第1~2天即下床活动,术后第2~3天拔除腹腔引流管,术后第8天拆除切口缝线,中位术后住院时间8(6~9)d。术后病理均为肾血管平滑肌脂肪瘤。所有患者术后均获随访,中位随访时间26(2~53)个月,无肿瘤复发。结论:腹腔镜辅助小切口“零缺血”巨大RAML切除术安全、可行。该术式充分结合了腹腔镜和开放手术的优势,既最大程度保护了肾功能,又减少了手术创伤,值得临床应用。Objective: To summarize the experience in laparoscopic-assisted small-incision zero-ischemia partial nephrectomy for huge renal angiomyolipoma, and to evaluate its safety andfeasibility. Method: A retrospective analysis was performed on the data of 9 cases who underwent laparoscopic-assisted small-incision zero-ischemia partial nephrectomy for huge renal angiomyolipoma in our hospital from July 2015 to October 2019. The nine patients included 4 males and 5 females. The median age was 43.7(36-78) years, and the median body mass index(BMI) was 24.6(19.5-32.9) kg/m^2. There were 3 cases of tumor on the right side and 6 cases of tumor on the left side. The median diameter of the tumor was 10.5(8.5-15.0) cm. One of the nine cases had gastric stromal tumor(diameter 2.0 cm) at the same time. The patients were administrated general endotracheal anesthesia and secured on the operating table in lateral decubitus with affected side elevated 70°.A 10-mm trocar was inserted at the medial margin of affected side umbilicus for laparoscope.Two trocars, with 10-cm spacing, were inserted under the costal margin of the affected side along the rectus abdominis for instruments. Firstly, the kidney and pedicle(not including the tumor) were dissociated under laparoscopy. Then a small incision was made between two trocar holes near the rectus abdominis of affected side. The junction between kidney and tumor was dissociated manually, and the kidney was squeezed with fingers without blocking the renal artery. The tumor was completely removed and the wound was sutured. One patient with gastric stromal tumor underwent laparoscopic resection at the same time. Result: All the 9 procedures were completed successfully. The median operative time was 150(120-210) min. The median estimatedblood loss was 220(150-350) mL. The median incision length was 11.2(10.0-13.5) cm. Noneof the nine patients received blood transfusion, and serious complications did not occur during and after operations. All patients had good postoperative recovery with good wo

关 键 词：腹腔镜 小切口 零缺血 肾血管平滑肌脂肪瘤 

分 类 号：R737.11[医药卫生—肿瘤]