非阻断肾动脉腹腔镜肾部分切除术治疗T_(1a)期肾癌的临床研究

Clinical Research of Laparoscopic Partial Nephrectomy for T_(1a) Renal Cell Carcinoma without Clamping of Renal Artery

目的探讨非阻断肾动脉腹腔镜肾部分切除术治疗T1a期肾癌的临床经验与治疗效果。方法回顾性分析我单位2008年6月至2012年6月期间收治的93例T1a期肾癌患者的临床资料,其中男性61例,女32例,肿瘤直径[2.9±0.5(1.0～3.9)]cm,肿瘤位于左肾43例,右肾50例。所有患者均行非阻断肾动脉腹腔镜肾部分切除术。记录手术时间、术中出血量、术后住院时间、术中及术后并发症、术后肾功能及术后恢复情况。结果所有手术均顺利完成,无中转开放手术者,手术时间[93±16(70～140)]分钟。术中出血[110±28(20～280)]ml,均未输血。术后住院时间[9.5±2.0(7～15)]天。术后病理报告切缘均为阴性。术前尿素氮及肌酐的均值分别为(5.0±0.7)mmol/L、(68.4±15.3)μmol/L;术后1周复查血尿素氮及肌酐均值分别为(5.6±0.8)mmol/L、(73.7±11.6)μmol/L(P>0.05)。术中及术后无明显并发症。术后随访[37±4.5(12～60)]个月,患侧肾功能正常,肿瘤无复发及转移。结论非阻断肾动脉腹腔镜肾部分切除术治疗T1a肾肿瘤安全、有效,可将潜在的肾脏热缺血损伤降至最低。

out clamping of renal artery. Operation time,blood loss,postoperative hospital stay,the incidence of complica-tions,preoperative and postoperative renal function were record and analyzed. Results All the 93 operations were completed successfully with no conversions. The mean operative duration was[93 ± 16(70 ~140)]min, mean estimated blood loss was [110 ± 28(20~280)]ml,mean postoperative hospital stay was [9. 5 ± 2. 0(7~15)]days. Preoperative creatinine and BUN were respectively (5. 0 ± 0. 7)mmol/L,(68. 4 ± 15. 3)μmol/L, and (5. 6 ± 0. 8)mmol/L,(73. 7 ± 11. 6)μmol/L(P>0. 05)1 week after operation. There were no significant complications during and after sugery. Postoperative pathology showed the incisal margin were negative. All pa-tients had normal renal function and had no tumor recurrence or metastasis during a mean follow-up time of [37 ± 4. 5(12 ~60)]months. Conclusions Laparoscopic partial nephrectomy for T1a renal cell carcinoma without clamping of renal artery is safe,effective and can minimize the potential renal injury caused by warm ischemia.