后腹腔镜下肾部分切除术治疗肾肿瘤的疗效分析(附24例报告)

Therapeutic effect of retroperitoneal laparoscopic partial nephrectomy for kidney tumor:a report of 24 cases

目的比较后腹腔镜下肾部分切除术及开放性手术治疗肾脏肿瘤的疗效。方法对2006年1月-2010年1月的24例肾脏肿瘤患者行后腹腔镜下肾部分切除术,并与同期17例开放性肾部分切除术病例的手术效果、手术并发症、手术时间、术中失血量以及住院天数等进行比较分析,所有患者随访18～36个月,比较患肾功能恢复情况及肿瘤复发情况。结果 24例后腹腔镜下部分切除术患者中23例顺利实施腹腔镜手术,1例转为开放性手术,手术时间平均110(60～210)min,肾动脉阻断时间平均32(15～55)min,术中出血量平均100(30～200)ml,术后住院7～10d,恢复良好,手术并发症主要包括中转开放性手术1例(原因为术中解剖结构不清,肾区粘连严重,出血较多)、结肠损伤1例、手术区域血肿2例。开放性手术患者手术均顺利实施,并发症主要包括尿外渗1例、心力衰竭1例及深部脓肿1例,手术时间平均为180(120～360)min,术中出血量为平均250(200～600)ml,热缺血时间平均为17.5min。平均恢复时间腹腔镜组为4周,开放组为6周。两组患者随访期内均无肿瘤复发。复查肾图显示患肾功能部分受损(20%～40%),患者的肾功能均正常。结论后腹腔镜下肾部分切除术具有损伤小、恢复快、肿瘤切除完全、安全、可行的优点,是治疗肾脏肿瘤的理想手术方法。

Objective To explore the therapeutic effect and clinical value of retroperitoneal laparoscopic partial nephrectomy and open partial nephrectomy on the treatment of kidney tumor.Methods Retroperitoneal laparoscopic partial nephrectomy was performed in 16 cases of renal cell carcinoma and 8 cases of renal hamartoma.Open partial nephrectomy was performed in 13 cases of renal cell carcinoma and 4 cases of renal hamartoma.The operation effects,operation time,blood loss,postoperative analgesic and the length of hospital stay were compared between the two groups.All the patients were followed up for 18 to 36 months,and the recovery of renal function and the rate of tumor recurrence were examined.Results Twenty-three cases of retroperitoneal laparoscopic partial nephrectomy were technically successful（only in one case it was converted to open surgery owing to severe bleeding,indistinct anatomy and dense adhesion around kidney）,the mean operation time was 110（60-210） min,the mean ischemic time was 32（15-55） min,the mean blood loss was 100（30-200） ml.The postoperative complications included 1 case of colonic injury,2 cases of hematoma in the surgical field.All the open partial nephrectomy was carried out successfully.Postoperative complications were 1 case of urinary extravasation,1 case of heart failure and 1 case of deep abscess.The mean operation time was 180（120-360） min,the mean blood loss was 250（200-600） ml,the mean ischemic time was 17.5min.All patients recovered after operation,and the hospital stay was 7-10 days,and no tumor recurrence was found during a follow-up period of 18-36 months.The renal function was partially impaired（20%-40%）.Conclusion Retroperitoneal laparoscopic partial nephrectomy is a minimally invasive,safe and feasible operative procedure with quick recovery.It is an ideal surgical method for treatment of kidney tumors.