后腹腔镜下根治性肾切除术并区域淋巴结清扫术40例报告

Retroperitoneai iaparoscopic radical nephrectomy and regional clearance of lymph nodes（report of 40 cases）

目的探讨后腹腔镜下肾癌根治性肾切除术并区域淋巴结清扫术的安全性和疗效。方法2002年1月至2006年7月,行后腹腔镜下肾癌根治区域淋巴结清扫术40例。男22例,女18例,年龄23～70岁,平均53岁。8例以无痛性全程肉眼血尿就诊,32例为体检时B超检查发现。B超检查肿物直径1．5～7．0 cm,平均5．0 cm;肿瘤位于肾上极16例,肾中部10例,肾下极14例。40例均行CT检查,31例行MRI检查,报告肿物大小与B超相符。术前临床分期：T1N0M09例, T2N0M025例,T3N0M06例。结果本组手术时间80～180 min,平均120 min。出血量20～300 ml,平均50 ml。无中转开放手术。术后肠道功能恢复时间（24±12）h,术后住院天数（7±2）d。术后无明显并发症。病理报告：肾透明细胞癌33例,囊性肾细胞癌4例,血管平滑肌脂肪瘤2例,嗜酸细胞瘤1例。送检清扫的淋巴结中,阳性4例,均为透明细胞癌,T21例、T23例。随访6～36个月,平均12个月,1例术后3个月局部复发,后因远处转移死亡,其余39例未发现局部复发和穿刺通道的种植性转移,未发现远处转移,均无瘤生存。结论后腹腔镜下肾癌根治性肾切除术并区域淋巴结清扫术安全可靠,疗效良好。

Objective To assess the safety and efficacy of retroperitoneal laparoscopic radical nephrectomy and regional clearance of lymph nodes. Methods A total of 40 patients （22 males and 18 females; age range, 23-70 years; mean age, 53 years） underwent retroperitoneal laparoscopic radical nephrectomy and regional clearance of lymph nodes from January 2002 to July 2006. Of the 40 cases, 32 were detected by B-ultrasound during physical examination and the rest 8 due to painless hematuria. The masses by B-ultrasound were on average 5.0 cm （range, 1. 5-7.0 cm） in diameter, with 16 masses at the upper pole of the kidney, 10 at the middle and 14 at the inferior pole. CT scan was performed on all the 40 cases and MRI on 31. The tumor size detected by CT and MRI was con sistent with that by B-ultrasound. Preoperatively, 9 cases had the tumors of clinical stage T3 N0 M0, 25 of T2 N0 M0 and 6 of T3N0 M0. Results The operative time was 80-180 rain （mean, 120 min）, and blood loss was 20-300 ml （mean, 50 ml）. Of the 40 cases, none required conversion to open surgery. The postoperative intestinal functional recovery time was 12-36 h （mean, 24 h）, and the post operative hospital stay was 5-9 d （mean, 7 d）. Pathology showed that 33 cases were of renal clear cell carcinoma, 4 of cystic renal cell carcinoma, 2 of hamartoma and 1 of oncocytoma. Of the 40 cases, 4 were reported positive lymph nodes. Postoperatively, 9 cases had the tumors of clinical stage T1N0M0, 24 of T2N0M0, 1 of T2N1M0, 3of T3N0M0 and 3of T3N1M0. During the follow up of 6- 36 months （mean, 12 months）, 39 patients survived and 1 died from local recurrence and distal metastasis. Conclusions Retroperitoneal laparoscopic radical nephrectomy and regional clearance of lymph nodes is effective and safe for small renal tumors.