套索法在后腹腔镜保留肾单位肾肿瘤手术中的应用

Retroperitoneal laparoscopic nephron-sparing surgery for renal tumors

目的探讨后腹腔镜保留肾单位手术中使用三套管自制套索法控制肾动脉临床应用的手术方法和临床效果。方法采用后腹腔镜技术对22例患者行肾部分切除术。男15例，女7例，年龄22-65岁，平均45岁。肾透明细胞癌13例，乳头状肾癌1例，肾血管平滑肌脂肪瘤8例。肿瘤大小1．0-8．0cm，平均3．2cm。结果22例手术均成功。手术时间120-200min，平均150min。肾动脉阻断时间12-38min，平均24min。术中出血量50-300ml，平均80m1。仅1例8em肾血管平滑肌脂肪瘤输血400ml。平均术后住院时间8d，围手术期无并发症。病理检查14例恶性肿瘤切缘阴性，随访5-29个月未见复发。结论后腹腔镜肾部分切除术安全可行，而三套管自制套索法控制肾动脉具有操作简便，干扰少，对肾脏腹侧肿瘤较易显露和操作，值得进一步推广和应用。

Objective To evaluate the feasibility and clinical efficacy of employing a homemade lasso to control the renal blood flow in retroperitoneal laparoscopic nephron-sparing surgery for the treatment of renal tumors. Methods Eight patients with benign renal tumors and 14 with malignant renal tumors underwent enucleation and wedge resection of renal tumors through retroperitoneal laparoscopy. Of these 22 patients, 15 were males and 7 females with a mean age of 45 years old. The mean tumor diameter was 3.2 cm. Results All the procedures were technically successful without conversion to open surgery in all 22 patients. The mean operative time was 150 min and mean blood loss 80 ml. The mean postoperative hospital stay was 8 days. No intraoperative or postoperative complication occurred. All 14 cases of malignant renal tumors had a negative surgical margin. With a follow-up of 5 -29 months, no recurrence occurred. Conclusion Retroperitoneal laparoscopic partial nephrectomy is feasible and safe for selective patients with renal tumors. Using a homemade lasso to control the renal blood flow in retroperitoneal laparoscopic partial nephrectomy is simple and less interferential.