腹腔镜保留肾单位手术治疗早期肾癌的临床研究(附32例报告)

Clinical study of laparoscopic nephron-sparing surgery for early malignant renal tumor(Report of 32 cases)

目的探讨腹腔镜保留肾单位手术治疗早期肾癌的方法和疗效。方法采用腹腔镜技术,术中使用超声刀、电凝钩对32早期肾癌患者行保留肾单位手术,患者年龄31～72岁,平均49±1.8岁。肿瘤平均直径1.5～4.5cm,平均(2.8±0.8)cm。25例行后腹腔镜保留肾单位手术,7例行经腹途径腹腔镜保留肾单位手术,影像学检查示32例肿瘤突出于肾脏表面,肾上极10例,肾下极13例,肾脏中部5例,近肾盂部位4例;偏背侧18例,腹侧14例。结果32例除1例转开放手术外,余31例为腹腔镜保留肾单位的肾肿瘤切除术。平均手术时间(105±15.4)min,平均出血量(120±21.6)ml,6例术中输血400ml。2例术后发生尿漏,予负压吸引15d后引流量小于20ml后拔出肾周引流管。术后住院时间平均7～17d,平均(9±2)d。术后病理报告:肾透明细胞癌28例,肾颗粒细胞癌3例,嗜酸性细胞癌1例。随访时间3～53个月,平均(21±4)个月,肿瘤无复发。结论腹腔镜保留肾单位术治疗早期肾癌安全、可行。

Objective To evaluate the possibility and clinical efficacy of laparoscopic nephron-sparing surgery for early malignant renal tumor. Methods A total of 32 patients（24 men and 8 women）with early malignant renal tumor were subjected to laparoscopic nephron-sparing surgery using ultrasound knife and electron microscopy. The mean patient age was 49±1.8 years.Among the 32 cases, 28 were clear cell renal careinoma,3 were granule cellrenal carcinoma,1 were oxyphil cell renal carcinoma.The mean diameter of tumor was 2.8±0.8 cm.Results All procedures were successfully completed without open conversion.Mean surgical time was 105±15.4 min, mean blood loss was 120±21.6 ml. The mean postoperative hospital stay was 9±2 days.During a mean follow up 20±4 months no patients has had local or port site recurrence.Conclusions Laparoscopic partial nephrectomy is not only feasible, but also safe.