射频消融辅助下不阻断肾蒂血管行腹腔镜肾部分切除术

Radiofrequency ablation-assisted laparoscopic partial nephrectomy without renal hilar vessel clamping： a report of 14 cases

目的探讨射频消融辅助下不阻断肾蒂血管行腹腔镜肾部分切除术（RF—LCPN）的可行性及临床疗效。方法2009年1月至2010年6月采用RF—LCPN治疗肾肿瘤14例，共14个肿瘤。肿瘤直径平均3．1（2．2～4．0）cm。临床分期均为T1aN0M0。术前常规查血肌酐（SCr）（87±36）μmol／L、患肾肾小球滤过率（GFR）（45±11）ml／min。结果14例患者手术均成功，平均手术时间（152±46）min，平均出血量（894-52）ml，术中快速病理提示标本切缘均阴性。术后出现短暂漏尿1例，通过放置输尿管双J管及留置导尿后治愈。术后平均住院（5±2）d。术后SCr（90±38）μmol／L，患肾GFR（41±12）ml／min，与术前比较差异无统计学意义（P〉0．05）。14例平均随访17（6～25）个月。无局部复发或远处转移病例。结论RF—LCPN安全有效，并能减少肾脏热缺血时间，但远期疗效尚需进一步观察后明确。

Objective To evaluate the clinical feasibility of radiofrequency ablation-assisted laparoscopic partial nephrectomy（ RF-LCPN ）without renal hilar vessel clamping. Methods From January 2009 to June 2010, 14 cases with renal tumors were treated with RF-LCPN. The mean tumor size was 3.1 cm （range： 2. 2-4. 0 era）. All cases were staged at T1aNoM0. The preoperative serum creatinine （SCr） was （87 ± 36） μmol/L and glomerular filtration rate （GFR） （45 ± 11 ） ml/min. Results RF-LCPN was technically successful in all patients （14 tumors）. The mean operative time was （152 ± 46 ） min and the mean blood loss （89 ± 52 ） ml. All tumor margins were negative. One patient with a brief period of urine leakage from lower pole calix was managed successfully by ureteral stenting and Foley catheter drainage of bladder. The postoperative hospital stay was （5 ± 2 ） days, The postoperative SCr was （90 ± 38 ） p, mol/L and GFR （41 ±12） ml/min. There was no statistic post-operative change of SCr and GFR （P 〉0. 05）. All patients completed a minimum follow-up of 6 months （ mean： 17 months, range： 6 - 25 months）. No evidence of local or port-site recurrence or metastasis was found. Conclusion As an accurate and effective intervention with a relatively low incidence of complications, RF-LCPN may eliminate renal warm ischemia. But its long-term efficacy remains to be further studied.