非阻断肾蒂的腹腔镜肾部分切除术

Transperitoneal Laparoscopic Partial Nephrectomy without Hilar Occlusion

目的探讨非阻断肾蒂的腹腔镜肾部分切除术的手术技巧与临床效果。方法回顾性分析2006年6月至2008年12月间24例肾肿瘤行肾部分切除术的治疗效果,术中均采用大圆针贯穿缝扎肾实质的方法阻断肿瘤部分肾实质的血流,将肿瘤切除后,腹腔镜下缝扎包埋创面,记录手术时间、术中出血量、术后并发症及术后恢复情况。结果 24例腹腔镜肾部分切除手术均获成功。手术时间75～160分钟,平均95分钟。术中出血量20～320 ml,平均115 ml。术后住院时间6～12天,平均7.5天。术中术后未出现明显并发症。术后随访12～42个月,剩余肾脏功能良好,未见肿瘤复发。结论采用肾实质贯穿缝合的方法行肾部分切除术,可不需阻断肾蒂,术中出血量少,可避免肾脏热缺血对肾功能的影响。

Objective To evaluate the feasibility and the clinical value of transperitoneal laparoscopic partial nephrectomy.Methods Transperitoneal laparoscopic partial nephrectomy was performed in 24 cases of renal carcinoma from June 2006 to December 2010.The suture was placed across the renal parenchyma 2-3 cm proximal to the resection line.After tumor excision,the renal defection was repaired and hemostatic agents were used to aid in achieving compressive hemostasis.Results All the operations were successfully accomplished.The operation time was 75-160 min,mean 95 min.The intraoperative blood loss was 20-380 ml,mean 115 ml, Convalescence well after operation and the hospital stay was 6-12 d,mean 7.5 d,No tumor recurrence was found during a follow-up of 12-24 m.Conclusions Regional renal parenchymal suture is safe and effective in the laparoscopic partial nephrectomy,which helps to create a bloodless operative field in select patients with optimally located renal tumors.