后腹腔镜保留肾脏手术治疗肾肿瘤

Retroperitoneal laparoscopic nephron-sparing surgery for renal tumor

目的探讨后腹腔镜保留肾脏手术治疗肾肿瘤的手术方法和临床效果.方法采用后腹腔镜技术使用超声刀对13例肾良性肿瘤和5例肾恶性肿瘤患者分别行肿瘤剜除术和肾楔形切除术.男7例,女11例.平均年龄51岁.肿瘤直径1.5～4.0 cm,平均2.8 cm.观察手术时间、术中出血量、术后住院天数和术中术后并发症及手术效果.结果18例手术均获得成功.平均手术时间87 min,平均出血量55 ml,平均术后住院时间5.8 d.围手术期无并发症.病理检查5例恶性肿瘤切缘阴性,平均随访10个月无局部复发.结论后腹腔镜肾部分切除术安全可行,切除肿瘤精确彻底,创伤小,恢复快,值得临床有选择地推广使用.

Objective To evaluate the feasibility and clinical efficacy of retroperitoneal laparoscopic nephron-sparing surgery for the treatment of renal tumor. Methods Thirteen patients with benign renal tumor and 5 with malignant renal tumor underwent enucleation and wedge resection of the renal tumor through retroperitoneal laparoscopy, respectively.Of the 18 patients,7 were men and 11 were women.Their mean age was 51 years.The mean tumor size was 2.8 cm in diameter (range,1.5-4.0 cm).The surgical techniques involved preoperative ureteral catheterization, dissection of the renal artery and placement of a tourniquet encircling the renal artery, transient atraumatic occluding of the renal artery with the tourniquet (if necessary),caliceal suture repair (if necessary) and renal parenchymal suture repair with intracorporeal free hand suturing techniques.The tumor resection and hemostasis were achieved mainly by Harmonic Scalpel.The operative time,blood loss,perioperative complications and operative effect were evaluated. Results All the procedures were technically successful without conversion to open surgery in the 18 patients.The mean operative time was 87 min and mean blood loss was 55 ml.The mean postoperative hospital stay was 5.8 d.No intraoperative or postoperative complication occurred.Pathological examination confirmed renal cell carcinoma (RCC) in 5 patients and angiomyolipoma in 13.All the 5 cases of RCC had negative surgical margins for cancer.Neither local recurrence nor metastasis was observed during a mean follow-up of 10 months. Conclusions Our results indicate that retroperitoneal laparoscopic partial nephrectomy is feasible and safe for selective patients with renal tumors.This procedure has the advantages of precise and complete tumor excision,minimal invasion,less complications and shorter convalescence.