腹腔镜下肾肿瘤保留肾单位手术体会

Laparoscopic nephron sparing nephrectomy

目的探讨腹腔镜下肾肿瘤保留肾单位手术（NSS）的安全性和可靠性。方法腹腔镜下NSS手术72例。男43例，女29例。平均年龄47岁。肿瘤最大径平均3．0（1．5～8．0）cm。术前CT检查诊断为肾细胞癌者64例，均为T1。手术常规建立4个通道，于肿瘤周围3cm处清除脂肪并作切除标记，阻断肾血管后切除肿瘤，创面用钛夹或可吸收缝线缝合止血，创面填塞止血纱布条，1-0Dixon缝线连续交叉缝合，Hem—o-lok间断固定缝线。结果手术成功71例，中转开放1例；手术时间平均125（90～190）min；热缺血时间平均22（12～40）min；术中出血量平均110（20～600）ml，术中输血1例，术后输血4例。病理报告透明细胞癌52例、血管平滑肌脂肪瘤14例、嫌色细胞癌5例、集合管癌1例；术后切缘阳性2例，均为血管平滑肌脂肪瘤。术后发生尿瘘1例，留置双J管2周后自愈。住院时间平均7（5～12）d。术后随访72例，平均随访时间26（1～52）个月。患肾功能良好，肿瘤无复发及转移。结论腹腔镜下NSS操作难度大，采用连续交叉缝合、间隔Hem—o—lok固定可降低手术难度，缩短肾缺血时间，减少并发症。

Objective To explore the safety and efficacy of laparoscopic nephron sparing nephrectomy for renal tumor. Methods The data of 72 patients diagnosed as renal rumor and treated with laparoscopie nephron sparing nephreetomy were retrospectively analyzed. Procedure detailed as following： firstly, the renal tumor was exposed completely after routine institution of 4 passages; secondly, the tissue 3 cm around the tumor was labeled and then incised using cool scissors after Bulldog occlusion of the renal artery; thirdly, the lesion was covered with anti-bleeding gauze and then inter-mittently sutured using 1-0 absorbable Dixon suture and crossing Hem-o-lok. Results Operation time was 90--190 rain, with warm ischemia time 12--40 min. Bleeding volume was 20--600 ml, with one intra-operative infusion and 4 post-operative infusions. Pathological diagnosis was clear cell RCC in 52 cases, angiomyolipoma in 14, chromophobe RCC in 5, and collective duct cancer in 1 case. Hospitalization time was 5--12 days. With 1 52 months follow-up, no tumor recurrence and metastasis was observed. Conclusions Treatment by laparoscopic nephron sparing nephrectomy for renal tumor could be safe and efficient, but operative experiences and skills are needed. The method of intermittent suture and crossing Hem-o-lok could be useful to shorten the operation time and reduce the complications.