保留肾单位手术治疗肾错构瘤的临床体会

Clinical experience of nephron-sparing surgery in the treatment of renal hamartoma

目的:探讨肾错构瘤的诊断及手术方法,并观察其临床疗效。方法:回顾分析2009年10月至2011年9月为41例肾脏错构瘤患者行保留肾单位手术的临床资料,其中男10例,女31例;18～79岁,平均(42.5±13.4)岁;左侧19例,右侧22例;肿瘤直径2.0～15 cm,平均(5.9±3.5)cm。结果:41例手术均获成功,9例行开放肾肿瘤剜除术,32例行腹膜后腹腔镜肾肿瘤剜除术;手术时间48～150 min,平均(63.8±18.9)min;热缺血时间18～30 min,平均(23.9±3.4)min;术中出血量60～210 ml,平均(86.0±28.4)ml;术后住院7～11 d,平均(7.6±0.8)d,术后病理均为肾错构瘤。随访3～12个月,均无复发。结论:保留肾单位手术是治疗肾错构瘤安全、有效的方法,但术者需具备丰富的手术经验。

Objective：To discuss the diagnosis and operative method,and evaluate the clinical efficacy of nephron-sparing surgery for renal angiomyolipoma.Methods：The clinical data of 41 cases of renal angiomyolipoma treated by nephron-sparing surgery from Oct.2009 to Sep.2011 were retrospectively analysed.10 patients were male,31 patients were female.The mean age was（42.5±13.4） years old（from 18 to 79 years old）.Nineteen cases were on the left side.and twenty-two on the right.Tumor diameter was 2.0-15 cm,mean diameter was（5.9±3.5） cm.Results：All the procedures were accomplished successfully,nine cases were treated by open nephron-sparing surgery and thirty-two cases were treated by retroperitoneal laparoscopic nephron-sparing surgery.Mean operative time was（63.8±18.9） min（from 48 min to 150 min）.Mean warm ischemia time was（23.9±3.4） min（from 18 min to 30 min）and mean blood loss was（86.0±28.4） ml（60 min to 210 ml）.Mean hospital stay after operation was（7.6±0.8） d（from 7 to 11 days）.41 cases of renal angiomyolipoma were confirmed by postoperative pathological tests.None recurred during the follow-up from 3 to 12 months.Conclusions：Nephron-sparing surgery is a safe and effective therapy for renal angiomyolipoma,but it must be accomplished by seasoned doctors.