后腹腔镜保留肾单位的肾部分切除术治疗T_1期肾肿瘤(附22例报道)

Laparoscopic nephron-sparing partial nephrectomy for the treatment of T_1 renal tumors(report of 22 cases)

目的探讨后腹腔镜保留肾单位的肾部分切除术治疗T1期肾肿瘤的手术方法及临床疗效。方法回顾性分析22例行后腹腔镜保留肾单位的肾部分切除术的T1期肾肿瘤患者的临床资料,其中男8例,女14例,平均年龄48岁。双侧肾肿瘤1例,单侧双瘤灶1例;左侧13例,右侧10例。肿瘤平均直径3cm。所有患者均行后腹腔镜保留肾单位的肾部分切除术。结果 22例手术均顺利完成。平均手术时间135min,平均肾动脉阻断时间29min,平均出血量55ml,平均住院时间10d。术中未见外科并发症,术后仅1例发生漏尿。术中切缘组织病理均阴性。24个瘤灶术后病理证实为肾透明细胞癌19例、多房囊性肾细胞癌2例、肾嗜酸细胞瘤2例、肾嫌色细胞腺癌1例。随访时间1～28个月,平均10个月,肿瘤无局部复发及远处转移。结论后腹腔镜保留肾单位的肾部分切除术治疗T1期肾肿瘤安全、可行,其远期疗效尚待长期随访。

Objective To investigate the surgical technique and therapeutic effect of retroperitoneal laparoscopic nephron-sparing partial nephrectomy for T1 stage renal tumors.Methods To retrospectively analyze the clinical data of 22 cases underwent retroperitoneal laparoscopic nephron-sparing partial nephrectomy for T1 stage renal tumors.8 cases were male and 14 cases were female,and the average age was 48 years old.Among them 1 case was bilateral renal tumor,and 1 case was unilateral double tumor foci,13 cases were on left kidney,and 10 cases were on right kidney.The average diameter of tumor masses was 3.0 cm.All patients underwent retroperitoneal laparoscopic nephron-sparing partial nephrectomy.Results All operations were completed successfully.The average operative duration was 135 min,the average renal artery occlusion time was 29 min,the average blood loss was 55 ml,and the averagehospital stay was 10 days.There was no intraoperative suigical complications,and only 1 case was present with leakage of urine.Intraoperative pathological margins were negative,and postoperative pathology was as follows：19 cases were renal cell carcinoma,2 cases were multilocular cystic renal cell carcinoma,2 cases were renal oncocytoma,and 1 case was chromophobe renal cell adenocarcinoma.All cases were followed up from 1 to 28 months,the average follow-up time was 10 months.The follow-up indicated there were no local recurrence and distant metastasis.Conclusions Laparoscopic nephron-sparing partial nephrectomy for T1 renal tumors is safe and feasible,its long-term effect remains to be the long-term follow-up.