中央型肾癌与外周型肾癌的腹腔镜保留肾单位手术对比研究

The comparative study on laparoscopic partial nephrectomy for central and peripheral renal tumors

目的对比中央型肾癌与外周型肾癌腹腔镜保留肾单位的手术特点。方法行保留肾单位手术的肾癌患者64例,中央型肾癌15例和外周型肾癌49例。比较两种肺癌患者手术时间、阻断方式及时间、术中出血和术后并发症发生情况。结果 15例中央型肾癌组患者手术顺利,平均手术时间(140.1±47.2)min,术中均采用选择性肾段动脉阻断,阻断时间(28.5±9.2)min,平均出血量为(170.3±40.3)mL,术后出现尿瘘2例,肾周血肿1例;49例外周型肾癌组患者手术顺利,平均手术时间(123.2±39.3)min,术中均采用单纯肾动脉完全阻断,阻断时间(19.3±6.2)min,平均出血量(139.5±35.1)mL,术后发生继发性出血1例,无尿瘘发生。结论术前准备细致和手术操作规范,保留肾单位手术对于中央型肾癌是安全可行的。

Objective To compare the operation characteristic and clinical experience of laparoscopic nephron sparing surgery for central and peripheral renal tumors. Methods A total of 64 cases of laparoscopic partial nephrectomies for renal tumors were divided into two groups：IS cases of laparoscopic partial nephrectomies for central type renal tumors and 49 cases of laparoscopic partial nephrectomies with peripheral type renal tumors. Operation time, blood vessel blocking time, intraoperative bleeding and postoperative complications of two groups are compared. Results For the patients with central renal tumors, mean operative time was （140.1±47.2） minutes. Mean isehemie time was （28.5±9.2） minutes. Mean blood loss was （170.3±40.3） mL.The major post-operative complication included leakage of urine（two cases ） and perirenal hematoma （one case）. For the patients with peripheral based tumors, mean operative time was （123.2±39.3） minutes. Mean ischemic time was （19.3±6.2） minutes. Mean blood loss was （139.5±35.1）mL. The major postoperative complication included postoperative bleeding （one case）. Conclusion Through careful preoperative preparation and standard operation technique , the nephron sparing surgery of centrally localized renal tumors is safe.