后腹腔镜肾小肿瘤剜除术12例报告

Retroperitoneal Laparoscopic Enucleation for the Treatment of Small Renal Tumor:Reports of 12 Cases

目的探讨后腹腔镜下肾浅在小肿瘤(<3cm)剜除术中不阻断肾动脉的可行性。方法 2005年4月～2009年4月对12例肾单发直径1.2～3.0cm的小肿瘤行后腹腔镜肿瘤剜除术。术中游离肾动脉,预置血管夹,以备肾动脉阻断;常规不阻断肾动脉情况下,距离肿瘤边缘1cm以上褥式外翻缝合1～2针,收紧缝线打结,预先缝线阻断肾肿瘤区血供;距离肿瘤边缘0.5～1cm,剜除肾肿瘤。结果 12例后腹腔镜手术均获成功,无中转开放手术。手术时间90～170min,平均130.3min;1例剜除肾肿瘤时出血较明显,需阻断肾动脉,时间约20min。术中出血量80～400ml,平均150.6ml,无大出血输血病例。3例术后出现肉眼血尿,均在术后3d内消失。住院时间5～7d,平均6.7d。术后病理:肾脏透明细胞癌10例,错构瘤2例,切缘均阴性。12例术后随访3个月～3年,平均15.5月,复查肾功能正常,B超、CT检查无肿瘤复发,无肾脏萎缩。结论后腹腔镜肾小肿瘤剜除术中预先缝线阻断肾局部肿瘤区血供,不阻断肾动脉是安全可行的。

Objective To discuss the feasibility of enucleation for the treatment for shallow and small renal tumor（3 cm）without blocking the renal artery.Methods A total of 12 patients underwent enucleation in our hospital from April 2005 to April 2009 by means of retroperitoneal laparoscopy.All of the patients had unilateral tumor with the diameter 1.2-3.0 cm.During the operations,the renal artery was dissociated,and the pre-placed blood vessel was clamped to block the renal artery.Conventional methods without blocking the renal artery was carried out,1 cm away from the tumor edge the mattress type eversion was made with suturing for 1-2 needles.The sewing thread was tightened to tie a knot,while the sewing thread blocked the renal tumor area blood supply in advance.Finally,0.5-1 cm away from the tumor edge,the renal tumor was enucleated.Results The operations were successfully completed in all of the patients without conversion to open surgery.Operation time ranged from 90 to 170 min with a mean of 130.3 min.During the operation,one patient had to receive renal artery block because of obvious bleeding,which took approximately 20 min.In this series,the intraoperative blood loss was 80-400 ml（mean,150.6 ml）.No patients received blood transfusion.After the operation,3 patients developed gross hematuria,but was cured spontaneously in 3 days.The mean hospital stay of this series was 6.7 days（ranged from 5 to 7 days）.Postoperative pathological examination showed kidney transparent cell cancer in 10 patients and hamartoma in 2;no positive cut edge was found.The patients were followed up for 3 month to 3 years（mean,15.5 months）,during which kidney function was normal in all the cases,and B-ultrasonography and CT found no tumor recrudescence,nor kidney atrophy.Conclusions During simple enucleation for the treatment of renal tumor by retroperitoneal laparoscopy,it is feasible to block the blood supply to the kidney partial tumor area in advance without blocking the renal artery.