后腹腔镜水刀辅助零阻断肾部分切除术治疗T_(1a)肾肿瘤的临床体会(附8例报告)

Water-jet assisted retroperitoneal laparoscopic partial nephrectomy without blockage of renal artery for T_(1a) renal cell carcinoma:with a report of 8 cases

目的:探讨后腹腔镜水刀辅助零阻断肾部分切除术治疗T1a期肾肿瘤的临床经验与疗效。方法:回顾分析2011年10月至2012年11月8例T1a期肾肿瘤患者的临床资料,其中男6例,女2例,平均(38.2±10.4)岁,左侧5例,右侧3例;肿瘤直径平均(2.8±0.9)cm。8例患者均行后腹腔镜水刀辅助零阻断肾部分切除术。结果:8例手术均顺利完成,无一例中转开放手术,围手术期无严重并发症发生。手术时间平均(103.2±24.5)min,术中出血量平均(250.3±80.6)ml,肾周引流管平均留置(6.3±2.6)d,术后平均住院(8.3±1.6)d。术后平均随访(5.2±2.1)个月,患者肾功能正常,未见肿瘤复发及转移。结论:后腹腔镜水刀辅助零阻断肾部分切除术治疗T1a肾肿瘤安全、有效、患者创伤小,可避免残留肾脏组织的热缺血及缺血再灌注损伤,在肿瘤彻底切除的基础上肾功能得到最大限度地保留;但远期疗效尚需大样本研究及长期随访。

Objective：To introduce the clinical experience and effects of water-jet assisted retroperitoneal laparoseopic partial nephrectomy without blockage of renal artery for T1a renal cell carcinoma. Methods：Eight patients （6 males and 2 females） with T1a renal cell carcinoma who were treated from Oct. 2011 to Nov. 2012 were retrospectively analyzed. The patients had a mean age of （38.2 ＋ 10.4） years old and a mean tumor size of （2.8 ±0.9） cm in diameter,with 5 cases on the left side and 3 cases on the right side. All of the 8 patients received water-jet assisted retroperitonea] laparoseopie partial nephrectomy without blockage of renal artery. Results： All the 8 cases were operated successfully without conversion to open surgery, and there were no severe perioperative complications. The mean operation time was （103.2 ±24.5 ） rain, mean blood loss was （250.3 ±80.6） m], and the mean indwelling duration of periuephrie drainage tube was （6.3 ±2.6 ） days, the mean postoperative hospital stay was （ 8.3 ±1.6 ） d. All patients had normal renal function and had no tumor recurrence or metastasis during a mean follow-up time of （5.2 ±2.1 ） months. Conclusions：Water-jet assisted retroperitoneal laparoseopie partial nephrectomy without blockage of renal artery is safe, effective and mini-invasive for treatment of patients with T1a renal cell carcinoma, warm isehemia and ischemia reperfusion injury can be avoided, renal function is maximally reserved on the basis of radical resection of tumors, however, the long term effects still need large sample studies and long term follow-up.