后腹腔镜下肾部分切除术23例报告

Retroperitoneal iaparoscopic partial nephrectomy(report of 23 cases)

目的探索后腹腔镜下肾部分切除术的应用范围和经验。方法2001年12月至2005年10月,对23例患者施行后腹腔镜下肾部分切除术,其中肾细胞癌14例、错构瘤5例、重复肾4例,孤立肾1例。结果22例手术顺利完成,1例肾肿瘤因仅阻断肾动脉前支时出血而行腹腔镜肾切除,手术时间60～240min,平均121min。肾动脉阻断时间20～55min,平均32min。术中出血量100～300ml,均未输血。病理报告肾细胞癌14例,切缘均阴性；错构瘤5例。1例重复肾因切除不彻底,术后发现肾上极囊性肿块而再次开放手术行肾部分切除。结论后腹腔镜下肾部分切除术对选择性的肾脏病变是一种有效和微创的治疗方法,远期效果有待进一步观察。

Objective To report initial experience and the indications of retroperitoneal laparoscopic partial nephrectomy： Methods From December 2001 to October 2005,23 patients （including 14 cases of renal cell carcinoma,5 of hamartoma and 4 of duplex kidney） underwent retroperitoneal laparoscopic partial nephreetomy. One of the patients had solitary kidney, Results All the operations were successful except for only 1 requiring conversion to laparoscopic nephrectomy because of bleeding resulting from blocking anterior branch of renal artery. The mean operative time was 121 min （60 -240 min） , and mean ischemic time was 32 min （20 -55 min）. The estimated bleeding volume ranged from 100 ml to 300 ml,and no patient needed blood transfusion. Pathology showed negative surgical margins in 14 cases of renal cell carcinoma and confirmed the diagnosis of hamartoma in 5 cases. One patient with duplex kidney required open partial nephrectomy because of renal cystic mass resulting from incomplete resection. Conclusions Retroperitoneal laparoscopic partial nephrectomy offers a new effective and minimally invasive treatment for selected patients with renal mass. The long-term effects of the procedure need further investigation.