后腹腔镜保留肾单位手术治疗肾血管平滑肌脂肪瘤

Retroperitoneal laparoscopic nephron-sparing operation for the treatment of renal angiomyolipoma

目的比较后腹腔镜保留肾单位手术与开放性保留肾单位手术治疗肾血管平滑肌脂肪瘤(RAML)的疗效。方法回顾性分析35例RAML行保留肾单位手术的临床资料,其中15例行后腹腔镜保留肾单位手术,作为腔镜组;20例行开放性保留肾单位手术,作为开放组。结果腔镜组:平均热缺血时间18min(15～30min),无中转开放手术,无术中输血,无明显术后并发症;开放组:平均热缺血时间为35min(30～40min),1例术后继发出血行右肾切除术,其余患者无明显术后并发症。两组患者年龄、肿瘤直径、手术时间和术后住院天数比较差异无统计学意义(P>0.05),但是腔镜组术中出血量和术后肠功能恢复时间明显少于开放组,差异有统计学意义(P<0.05)。术后患者随访3～60个月,未见肿瘤复发。结论后腹腔镜保留肾单位手术是一种对部分RAML患者安全可行、创伤小、恢复快的手术方式,值得推广应用。

Objective To compare the treatment effect of renal angiomyolipoma（RAML） between retroperitoneal laparoscopic nephron-sparing operation and open nephron-sparing operation. Methods The clinical data of 35 patients were analyzed, who suf-fered from RAML and received partial nephrectomy. 15 cases were laparoscopic group, who underwent by retroperitoneal laparo- scopic partial nephrectomy,20 cases were open group,who received open partial nephrectomy. Results Laparoscopic group：the av-erage warm ischemia time was 18 min（15-30 rain）, without conversion to open operation, blood transfusion,or postoperative com- plications;Open group：the average warm ischemia time was 35 min（30-40 min）, one patient underwent right nephrectomy because of hemorrhage after operation, the others had no postoperative complications, there was no statistical significance in patients＇ age, tumor diameter, the operation time and hospitalization days after operation between two groups（P〉0. 05）, but laparoscopic group was less than open group in the volume of intraoperative bleeding and the recovery time of intestinal function after operation（P〈0. 05）. The patients were followed up about 3-60 months, no tumor recurred. Conclusion Retroperitoneal laparoscopic nephrow sparing operation is worthy of selective a＇pplication for some patients with RAML,which is a kind of safe and feasible,less trauma, and quicker recovery operation.