后腹腔镜肾部分切除术治疗T_(1a)期肾癌

Retroperitoneal laparoscopic partial nephrectomy in patients with T_(1a) renal cell carcinoma

目的:探讨后腹腔镜肾部分切除术治疗T1a期肾癌的临床价值。方法:回顾性分析2011年9月至2012年12月16例采用后腹腔镜肾部分切除术治疗的T1a期肾癌患者的临床资料,评价手术方法的优点和缺点。结果:16例手术均顺利完成,无中转开放手术者。手术时间为100-155min。16例均单纯阻断肾动脉,热缺血时间为20-30min。术中失血量120-260ml。术后镇痛药用量6-40mg(相当于硫酸吗啡量);引流管留置时间2-3d,进食时间18-36h,住院天数7-12d。无术后出血、感染、漏尿等并发症。术后病理检查均为肾透明细胞癌,切缘均为阴性。随访1-16个月均健在,肿瘤无局部复发、转移。随访期间患者肾功能均正常。结论:后腹腔镜肾部分切除术治疗T1a期肾癌安全可行,具有创伤小、恢复快等优点,但远期疗效需进一步观察。

Objective：To investigate the clinical value of retroperitoneal laparoscopic partial nephrectomy in patients with T1a renal cell carcinoma.Methods：Sixteen patients with T1a renal cell carcinoma treated with retroperitoneal laparoscopic partial nephrectomy from September 2011 to December 2012 were retrospectively analyzed,to evaluate the advantage and disadvantage of the surgery.Results：The sixteen patiens were operated successfully,without conversion to open surgery.The operation time was 100-155 minutes,16 cases blocked the renal artery only,the warm ischemia time was 20-30 minutes.The intraoperative blood loss was 120-260ml.The administration of analgesics was 6-40mg（equivalently morphine sulfate dose） postoperative;the drainage tube was removed 2-3 days,the eating time was 18-36 hours,and the hospitalization period was 7-12 days.No complications like postoperative bleeding,inflammation and leakage of urine was found.Postoperative pathology of all cases were renal clear cell carcinoma,and all the margins were negative.All cases were living in good health during the followed up period from 1 to 16 months,there were no local recurrence and distant metastasis.During the follow-up period the renal function of all patients were normal.Conclusion：Retroperitoneal laparoscopic partial nephrectomy is safe and feasible,with the advantage of minimal invasive and can get a quick recovery,but its long-term effect remains to be the long-term follow-up.