腹膜后单孔腹腔镜肾部分切除术6例报告

Retroperitoneal Single-port Laparoscopic Partial Nephrectomy:Report of 6 Cases

目的探讨腹膜后单孔腹腔镜肾部分切除术的可行性。方法 2010年5月～2011年4月,采用单孔腹腔镜对6例肾肿瘤(4例T1N0M0,2例T2N1M0)行肾部分切除术。侧卧位、经腹膜后途径,4例使用Olympus单通道腹腔镜穿刺器,2例使用自制单通道穿刺器进行手术。结果 6例手术均顺利完成,手术时间65～210 min,平均130 min;肾动脉阻断时间20～40 min,平均28 min;术中出血量30～280 ml,平均110 ml,均无输血;无术后并发症。术后病理:局限性透明细胞癌4例,肿瘤直径平均22 mm(14～35 mm),切缘均为阴性;肾血管平滑肌脂肪瘤2例,肿瘤直径均为30 mm。术后住院时间5～11 d,平均8 d。6例随访1～11个月,平均6个月,肿瘤无复发。结论单孔腹腔镜经腹膜后肾部分切除术治疗小体积肾肿瘤可行,远期效果有待增加样本量进一步研究。

Objective To study the feasibility of retroperitoneal sigle-port laparoscopic partial nephrectomy. MethodsFrom May 2010 to April 2011,six patients with organ confined renal neoplasma underwent single-port laparoscopic partial nephrectomy,4 of the cases were in stage T1N0M0,the other 2 were T2N1M0.A triport or a home-made port was inserted through a retroperitoneal incision with the patient at lateral position. Results The operation was completed successfully in all the cases within a mean of 130 min（65-210 min）.The renal artery blockage time was 28 min in average（20-40 min）.The mean blood loss was 110 ml（30-280 ml）,no patient required blood transfusion.Pathological examination showed that 4 cases of renal cancer（clear cell cancer） with an average diameter of 22 mm（14～35 mm）;the other 2 cases were angiomyolipoma with a diameter of 30 mm.The mean hospital stay of the patients was 8 d（5-11 d）.No intraoperative or postoperative complications occurred.After a mean follow-up of 6 months（1-11 months）,all the patients recovered well without evidence of recurrence. Conclusions Retroperitoneal single-port laparoscopic partial nephrectomy is effective and feasible for selected patients.Further studies with larger sample size are needed to evaluate its long-term effects.