摘要
目的:探讨后腹腔镜肾部分切除术治疗肾脏早期占位性病变的临床效果。方法:2004年6月~2011年1月对47例早期肾占位性病变患者行后腹腔镜肾部分切除术,其中恶性病变43例,可疑恶性病变4例。结果:47例手术均获得成功,无中转开放手术和后腹腔镜肾根治性切除术。平均手术时间(105±21.4)min(75~140 min),平均肾动脉阻断时间(24±6.5)min(17~40 min),平均出血量(160±74)ml(70~600 ml)。术后病理检查报告为透明细胞癌39例,其中1例术后病理检查结果证实切缘阳性;肾嫌色细胞癌2例;肾嗜酸细胞瘤2例;肾脏囊性病变4例。术后主要并发症为迟发性出血1例,尿瘘2例。随访1~78个月,平均(32±10.6)个月,均未见局部复发和远处转移。结论:对于腹腔镜技术熟练的操作者而言,后腹腔镜肾部分切除术可以作为治疗早期肾脏占位性病变的首选。手术过程中的一些焦点问题仍需要深入探讨。
Objective:To evaluate the possibility and clinical efficacy of retroperitoneal laparoscopic partial nephrectomy for early renal tumors. Method:Retroperitoneal laparoseopic partial nepbreetomy was performed in 47 patients with early stage renal tumors from June 2004 to January 2011. The peri-operative data and follow-up da- ta, including local recurrence, distant metastasis were recorded. The data were retrospectively analyzed. Result: All the procedures were successfully accomplished with no conversion to open surgery or laparoscopic radical nephrec- tomy. The mean operative time was (105±21.4)minutes (range,75-140min). The mean blood loss was (160±74)ml (range,70-600 ml). Renal arteries were clamped with bulldog clamps in 41 cases and the mean warm ische mie time was (24±6.5)min (range, 17-40 rain). Pathological analysis showed that there were 41 renal cell carci noma(RCC) including clear cell RCC in 39 cases and ehromophobe RCC in 2 cases. There was 1 patient with a sttive margin on-final pathology for all the malignant cases. Six of 47 cases were benign diseases. The major urinary complications were delayed bleeding in 1 cases and urine leakage in 2 cases. Neither distant metastasis nor lo- cal recurrence was found in all patients after fellow up (32 +_ 10.6) mouths ( 1-78 months). Conclusion: Laparoscopic partial nephrectomy is a technically challenging procedure. In expert hands, LPN has emerged as a viable alternative to open partial nephrectomy. The focus of LPN such as surgical indication, warm iscbemic time,positive margin requires more exploration.
出处
《临床泌尿外科杂志》
北大核心
2011年第6期410-413,共4页
Journal of Clinical Urology