后腹腔镜下分支肾动脉阻滞肾部分切除术治疗肾肿瘤的临床分析

Retroperitoneal laparoscopic block arterial branches partial nephrectomy for the treatment of renal tumor

目的探讨后腹腔镜下分支肾动脉阻滞肾部分切除术治疗肾肿瘤的手术方式和临床效果。方法对肾肿瘤患者行后腹腔镜下肾部分切除13例临床资料进行分析。结果 13例手术均顺利完成,无中转开放及腹腔脏器损伤病例。平均手术时间(85.0±25.0)min,平均热缺血时间(24.0±13.0)min,术中平均出血(150.0±100.0)ml,无术中输血患者。术后病理确诊肾透明细胞癌10例、乳头状肾细胞癌2例、嫌色细胞癌1例,肿瘤切缘均阴性。术后未出现尿漏,未发生肉眼血尿。随访1～7个月,未见肿瘤局部复发。结论后腹腔镜下分支肾动脉阻滞肾部分切除术治疗肾肿瘤安全有效,手术创伤小,有可能替代后腹腔镜下肾动脉主干阻滞肾部分切除术。

Objective To evaluate the technique and efficacy of retroperitoneal laparoscopic block arterial branches partial Ne- phrectomy. Methods 13 cases （ age ranged from 26 to 73 years） with renal tumor received retroperitoneal laparoscopic partial nephrec- tomy between January 2011 to July 2011. The tumor located in left side in five cases and fight side in eight eases with the mean diameter of （3.4 ± 2.1 ） era. During the procedure, the renal arterial branches was separated and then clamped with bulldog. The renal paren- ehymal was incised with cold endoscissor and the tumor was totally removed. Pelvicalyceal repairing and parenchymal hemostasis was then performed. Renal defect closure was achieved with running suture or horizontal mattress suture. Results All the procedures were completed successfully. There was no open conversion. The mean operation time was （85 ± 25 ） rain, the mean warm ischemic time was （24 ± 13） rain. The pathology studies revealed 10 cases of clear cell carcinoma： 2 cases of papillary renal cell carcinoma, one case of chromophobe cell carcinoma, and the surgical margin was negative in all cases. There was no complication of urine leakage. During 17months of following - up, there was no recurrence. Conclusion Retroperitoneal laparoscopic block arterial branches partial nephrectomy is safe and effective for the treatment of renal tumor, which becomes an alternative treatment to open procedure.