腹膜后腹腔镜肾错构瘤剜除术治疗肾错构瘤破裂出血

Retroperitoneal laparoscopic renal hamartoma enucleation in treatment of renal hamartoma rupture and hemorrhage

目的:比较腹膜后腹腔镜肾错构瘤剜除术与开放手术治疗肾错构瘤破裂出血的临床疗效和随访结果。方法:回顾分析2003年5月至2008年10月为23例肾错构瘤破裂出血患者行错构瘤剜除术的临床资料。其中腹膜后腹腔镜手术9例,传统开放手术14例。对比两组的临床疗效及随访结果。结果:腹腔镜组均顺利完成手术,无一例中转开放手术。术中出血(254.2±48.5)ml,术后平均(39.6±11.8)h肠功能恢复,术后平均住院(7.5±3.2)d,平均(23.0±6.5)d后恢复正常工作,明显优于开放组。腹腔镜组并发症少于开放组。两组手术时间差异无统计学意义。两组平均随访(36.6±16.0)和(38.0±16.7)个月,23例均无复发,健康存活。结论:腹膜后腹腔镜肾错构瘤剜除术与开放手术相比,疗效相当,患者创伤小、痛苦少、术后康复快、并发症少,在积极抗休克治疗、生命体征平稳的条件下,可作为肾错构瘤破裂出血的首选治疗方法。

Objective： To compare the clinical therapeutic effect and follow up result of retroperitoneal laparoscopic renal hamartoma enueleation and laparotomy in treatment of spontaneous rupture and hemorrhage of renal hamartoma. Methods ： From May 2003 to Oct. 2008,23 patients with spontaneous rupture and hemorrhage of the renal hamartoma underwent hamartoma enueleation. 9 patients underwent retroperitoneal laparoseopie surgery and 14 patients were performed open surgery. The clinical data of the 23 cases were retrospectively analyzed ,clinical therapeutic effect and follow up result were comparatively studied. Results：In laparoseopic group, all the operations were successful without conversion to open surgery, the blood loss was （254.2 ± 48.5 ） ml, mean time of intestinal function recovery was （39.6 ± 11.8） h,postoperative hospital stay was （7.5 ± 3.2） d, after （23.0 ± 6.5 ） d patients returned to normal activities, which were much better than those in open group, and incidence of complications was significantly less than that in the open group. There were no differences in average operating time. Mean follow-up was （ 36.6 ± 16.0 ） and （ 38.0 ± 16.7 ） months, there was no recurrence and all the patients in two groups srowived and remained healthy. Conclusions：With active anti-shock therapy and stable vital signs,retroperitoneal laparoscopic renal hamartoma enucleation can be used initially for rupture and hemorrhage of the renal hamartoma with equivalent therapeutic effect to open approaches, while providing minimal invasion, less suffering, quicker postoperative recovery and less complications.