腹腔镜下保留肾单位的肾癌切除术(附15例报告)

Laparoscopic nephron-sparing surgery(report of 15 cases)

目的探讨腹腔镜下肾癌保留肾单位切除术的方法及治疗效果方法以AJCC2002年肾癌临床和病理分期为标准,选择临床分期为Ⅰ期、病理分期为T1a期(肿瘤最大径≤4cm)的外生型肾肿瘤15例,分别行腹腔镜下保留肾单位手术。其中经腹腔入路组6例,经后腹膜腔入路组9例。距肿瘤边缘0.5～1.0cm处进行局部切除。结果15例手术中14例完全在腹腔镜下完成,1例因腹腔镜下无法彻底止血而中转开放完成手术。14例腹腔镜手术时间110～200min,平均160min;术中失血量60～300ml,平均160ml;术后留置引流管时间3～7d,平均5d;术后引流液300～600ml,平均420ml;术后住院时间4～8d,平均5d。术后随访5～8个月,所有肿瘤均无局部或切口、远处复发,患者恢复良好。结论腹腔镜下保留肾单位的肾癌切除术损伤小、效果肯定、恢复快,短期随访结果令人满意。

Objective To explore the method of laparoscopical nephron-sparing surgery,and to observe its treatment effect. Methods From October 2007 to March 2008,15 cases were enrolled in this study. All the cases were incidental renal cell carcinoma,clinical stage Ⅰ and pathological stage T1a ,according to the AJCC 2002, and accepted laparoscopic nephron-sparing surgery. Patients were divided into two groups. Six cases were laparoscopied by transperitoneal approach and nine cases by transretroperitoneal approach. The tumors and tissue 0.5-1.0 cm around the margin were exsected. Results Fourteen patients were treated by laparoscopy completely,one patient was converted to open because of uncontrollably bleeding. The average laparoseopieal operation time was 160 （110 to 200）min,. The average blood loss was 160 （60 to 300）ml. The average post-operation draining time was 5（3 to 7）days. The average volume of draining was 420（300 to 600）ml. The post-operative stay time was 4 to 8 days. No recurrence,metastasis and implantation occurred in all cases during 5 to 8 months postoperative follow-up. Conclusions Laparoscopic nephron-sparing surgery has the advantages of minimal invasion, clear dissection and quick recovery.