后腹腔镜肾部分切除术治疗肾脏早期占位性病变的临床研究(附47例报告)

Clinical Study of Retroperitoneal Laparoscopic Partial Nephrectomy for Early Renal Tumors(Report of 47 Cases)

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.