超声监测下腹腔镜肾部分切除术治疗完全内生性肾肿瘤的疗效分析  

Analysis of the efficacy of laparoscopic partial nephrectomy in the treatment of completely endophytic renal tumors by ultrasound monitoring

作　　者：黄建文[1,2] 胡晓勇 陈磊[3] 张炯 郭辉[1,2] 罗志强[1,2] 曹乃龙 宋鲁杰[1,2] 傅强 HUANG Jianwen;HU Xiaoyong;CHEN Lei;ZHANG Jiong;GUO Hui;LUO Zhiqiang;CAO Nailong;SONG Lujie;FU Qiang(Department of Urology,Affiliated Sixth People's Hospital of Shanghai Jiao Tong University,Shanghai,200233,China;Shanghai Eastern Urological Reconstruction and Repair Institute;Department of Ultrasound,Affiliated Sixth People's Hospital of Shanghai Jiao Tong University)

机构地区：[1]上海交通大学附属第六人民医院泌尿外科,上海200233 [2]上海东方泌尿修复重建研究所 [3]上海交通大学附属第六人民医院超声科

出　　处：《临床泌尿外科杂志》2022年第4期252-256,共5页Journal of Clinical Urology

基　　金：上海市第六人民医院院级科学研究基金(No:YNLC201816)。

摘　　要：目的:探讨超声监测下腹腔镜肾部分切除术治疗完全内生性肾肿瘤的安全性和疗效。方法:分析2014年2月—2021年3月上海交通大学附属第六人民医院收治的18例完全内生性肾肿瘤的临床资料、术中情况、术后随访等。随机选取该期间收治的20例T_(1a)外生性肾肿瘤作为对照。结果:2组患者均顺利接受腹腔镜肾部分切除术,无中转开放或者肾切除手术,均完整切除肾肿瘤,其中内生性肾肿瘤患者在术中超声监测下行腹腔镜肾部分切除手术。内生肿瘤组的手术时间和热缺血时间分别为(161.4±22.5)min和(23.0±2.1)min,外生肿瘤组分别为(122.6±27.3)min和(18.4±2.6)min,2组比较差异有统计学意义(P<0.05)。但在肿瘤切缘、术中出血量、术后住院时间及并发症方面,2组比较差异无统计学意义(P>0.05)。所有患者均获得随访,平均随访时间46.3个月。术后患肾GFR下降方面比较,2组差异无统计学意义。内生性肿瘤组1例术后出现肾肿瘤复发;外生性肿瘤组1例术后出现肿瘤复发。2组患者均生存,无转移。结论:腹腔镜肾部分切除术是治疗完全内生性肾肿瘤的安全、有效方法。术中超声监测是完整切除内生性肾肿瘤,最大限度保护肾功能的关键,获得与外生性肾肿瘤相同的疗效。Objective:To explore the safety and efficacy of the treatment of aparoscopic partial nephrectomy(LPN)for completely endophytic renal tumors under ultrasound monitoring.Methods:We retrospectively analysed the clinical data of 18cases of completely endophytic renal tumors admitted to our hospital from February 2014to March 2021.Other 20cases of T_(1a) exophytic renal tumors treated with LPN during the period were randomly selected as a control group.Results:Both groups of patients successfully underwent LPN without conversion to open surgery or radical nephrectomy.All tumors were completely resected and completely endophytic renal tumors were resected with LPN under ultrasound monitoring.The surgery time and warm ischemia time were(161.4±22.5)min and(23.0±2.1)min,respectively in the endophytic renal tumor group,while the exophytic renal tumor group were(122.6±27.3)min and(18.4±2.6)min,respectively.The differences were statistically significant(P<0.05).However,the differences were not statistically significant in terms of positive cancer margins,intraoperative bleeding,postoperative hospitalization time or postoperative complications(P>0.05).All patients received follow-up,with an average follow-up time of 46.3months.There was no statistical difference between the two groups in terms of postoperative renal GFR decline.In the endophytic renal tumor group,1 case showed renal tumor recurrence after surgery,while in the exophytic renal tumor group,1case showed tumor recurrence after surgery.Both groups of patients survived without metastasis.Conclusion:LPN is a safe and effective method for treating completely endophytic renal tumors.Ultrasound monitoring in surgery is the key to completely removing endophytic renal tumors and maximizing the protection of kidney function,so as to ensure the same efficacy as exophytic renal tumors.

关 键 词：超声 腹腔镜 肾部分切除术 内生性 肾肿瘤 

分 类 号：R737.11[医药卫生—肿瘤]