后腹腔镜下肾部分切除术在单侧多中心性肾肿瘤治疗中的应用

Application of retroperitoneal laparoscopic partial nephrectomy in the treatment of unilateral multifocal renal tumors

目的 初步探讨后腹腔镜下肾部分切除术在多中心性肾肿瘤治疗中的安全性和有效性. 方法 回顾性分析2009年8月至2012年10月我院12例行后腹腔镜下肾部分切除术的多中心性肾肿瘤患者的临床资料.男4例,女8例.年龄28～62岁,平均42岁.体质指数18.6～29.3 kg/m2,平均23.5 kg/m2.4例肿瘤位于左肾,7例位于右肾,1例位于双肾.单侧肿瘤数量2～10枚,共41枚,直径0.5～4.7 cm,均向肾外凸出.9例术前诊断为肾细胞癌,其中3例为von Hippel-Lindau综合征;3例术前诊断为血管平滑肌脂肪瘤.12例均在全麻下行后腹腔镜下肾部分切除术,双肾肿瘤患者在后腹腔镜下肾部分切除术后3个月行对侧根治性肾切除术. 结果 12例手术均顺利完成,无中转开放者.肾动脉阻断时间26 ～ 60 min,平均36 min.手术时间75～184 min,平均126 min.出血量50～300 ml,平均142 ml.住院日3～9d,平均5d.术后均未出现漏尿、严重血尿等并发症,术后1周血肌酐为（78.1±8.1）μmol/L.术后病理诊断为9例肾细胞癌,3例血管平滑肌脂肪瘤,切缘均为阴性.12例均获随访,随访时间13～51个月,平均33个月.其中,1例yon Hippel-Lindau综合征透明细胞癌患者因局部复发行同侧根治性肾切除术,余患者未见复发和转移. 结论 后腹腔镜下肾部分切除术治疗多中心性肾肿瘤安全、有效,遗传性、恶性肾肿瘤患者术后应严密随访.

Objective To discuss the safety and efficacy of retroperitoneal laparoscopic partial nephrectomy in the treatment of unilateral multifocal renal tumors.Methods The data of 12 patients with unilateral multifocal renal tumors managed with retroperitoneal laparoscopic partial nephrectomy between 2009 and 2012 were reviewed retrospectively.The 12 patients had a mean age of 42 years （28 to 62） and body mass index of 23.5 kg/m2 （18.6 to 29.3）,including 4 males and 8 females.Four cases were in the left side,7 cases were in the right side,and 1 case had bilateral renal tumors.The diameter of renal tumors ranged from 0.5 cm to 4.7 cm,and all tumors were projected on the surface of kidney.Nine cases were diagnosed as renal cell carcinoma,and 3 cases were diagnosed as angiomyolipoma before operation.All patients underwent retroperitoneal laparoscopic partial nephrectomy under general anesthesia,while 1 patient with bilateral renal tumors experienced radical nephrectomy of the contralateral renal tumor 3 months after the first operation.Results All the oprations were successful without conversion to open surgery.The mean renal artery cut off time,operative time,estimated blood loss and hospital stay were 36 min （26-60）,126 min （75-184）,142 ml （50-300） and 5 d （3-9）,respectively.No complication occurred and 1-week postoperative serum creatinine was （78.1 ±8.1）μmol/L.Histopathological study revealed 9 cases of renal cell carcinomaand 3 cases of angiomyolipoma.During the follow-up for 33 months （13-51）,1 patient with yon Hippel-Lindau syndrome was operated with ipsilateral radical nephrectomy for a local recurrence while the remains had no local recurrence or metastasis.Conclusions For localized and exogenous unilateral multifocal renal tumors,retroperitoneal laparoscopic partial nephrectomy is feasible and safe.Those who have hereditary and/or malignant renal tumors should be monitored closely.