原位低温保留肾单位巨大肾错构瘤切除术

Nephron-sparing renal hamartectomy in situ hypothermia

目的探讨保留肾单位条件下巨大肾错构瘤切除术的方法。方法对本院2003～2007年16例肿瘤直径大于8cm的患者行原位低温、阻断肾动脉的方法，术中应用肌苷、速尿和甘露醇，成功切除肿瘤，最大限度保留肾单位。结果手术平均时间150（80～270）min，肾动脉平均阻断时间29（13～55）min，平均失血量190（60～350）mL，手术均顺利完成，无死亡患者。患者肿瘤直径平均10．2（8．0～22．0）cm，最大1例肿瘤为国内保肾手术切除之最。术后均无明显漏尿，术后3～6个月复查IVP示患肾排泄功能基本正常。结论原位低温条件下可提供较长的肾缺血安全手术时限，视野清晰，出血少，可减少因担心肾热缺血时间长损害肾功能而出现操作欠精细所致的损伤。肌苷、速尿及甘露醇等药物的应用，有效地改善肾热缺血的耐受性，保护了肾功能，并促进受损肾功能恢复。

Objective To investigate the surgical treatment for nephron-sparing renal hamartectomy. Methods We used in situ hypothermia and occlusion of renal artery to perform successfully renal hamartectomy in 16 cases in our hospital in 2003--2007, the diameter of tumors was greater than 6era. We used carnine, frusemide and manicol through vein during the operations. And so we served the renal functions as we could as. Results The average time of operation was 150（80-270）min. The average time of occlu- sion of renal artery was 29（13- 55）min. The average amount of bleeding was 190（60 -350）mL. All of operations were successful, and no patients died. The average diameter of tumors was 10.2（6.0-22.0）cm,and one was the greatest tumors cut off in the same way at home. No obvious leakage of urine was found after operation. After 3 6 months, IVP showed that excretory function of troubling kidneys were almost normal. Conclusion Under in situ hypothermia,we got enough time to perform renal hamartectomy, and operating field clear,less bleeding during operations. So we could avoid unexpected harm resulting from rash action. Carnine, frusemide and manicol were used to improve the tolerance of kidney to ischemia,protect the renal functions,and promote the recov- ery of kidney.