后腹腔镜下双波长激光辅助零缺血肾部分切除术16例报告

Retroperitoneal laparoscopic dual-wavelength laser assisted zero ischemia partial nephrectomy:a report of 16 cases

目的:探讨双波长激光辅助后腹腔镜不阻断肾动脉(零缺血)肾部分切除术的安全性及效果。方法:回顾性分析2016年12月～2018年3月我院收治的16例外生型肾肿瘤患者的临床资料,男11例,女5例;年龄42～68岁,平均55岁;肿瘤直径1.2～4.0cm,平均(2.6±0.7)cm;左侧6例,右侧10例;R.E.N.A.L.评分4～8分(4～6分12例,7～8分4例)。16例均采用双波长激光辅助行后腹腔镜不阻断肾动脉的肾部分切除术。激光采用Evolve双频激光系统(Biolitec AG,Germany),发射双波长激光(980nm/1 470nm)。结果:16例中2例因出血明显行肾动脉阻断后切除肿瘤,余均顺利完成手术。无中转开放手术或肾根治性切除病例。手术时间50～140min,平均(83.1±24.1)min;术中出血量50～400ml,平均(125.0±93.1)ml;术后排气时间1～3d;术后住院时间3～7d,平均5.3d。无术后严重并发症发生。术后1个月左右复查肾功能,术前血肌酐52～138mmol/L,平均(72.1±22.7)mmol/L;术后1个月血肌酐55～172mmol/L,平均(81.5±28.2)mmol/L,差异无统计学意义(P>0.05)。术后病理结果透明细胞癌13例,嫌色细胞癌1例,乳头状肾细胞癌1例,上皮样错构瘤1例。随访3～18个月,随访期间未见肿瘤复发、转移。结论:对于体积较小的外生型肾肿瘤,双波长激光辅助后腹腔镜不阻断肾动脉的肾部分切除术是可行的治疗方案,在肾功能保护方面达到了满意的效果。

Objective:To evaluate the safety and efficacy of dual-wavelength laser-assisted retroperitoneal laparoscopic off-clamping partial nephrectomy(zero ischemia).Method:From December 2016 to March 2018,16 cases of exogenic renal tumors were treated in Peking Union Medical College Hospital.There were 11 males and 5 females,aged 42-68 years old,with an average age of 55 years old.The diameter of tumor was 1.2-4.0 cm,with an average of(2.6±0.7)cm.Six cases were on the left side and 10 on the right side.The R.E.N.A.L.score was4-8 points(12 cases with R.E.N.A.L.score 4-6,4 cases with R.E.N.A.L.score 7-8).These 16 cases were treated by dual-wavelength laser assisted retroperitoneal laparoscopic partial nephrectomy without renal artery occlusion.Evolve dual-frequency laser system(Biolitec AG,Germany)was used to emit dual-wavelength laser(980 nm/1 470 nm).Result:Of the 16 cases,2 cases were resected after renal artery occlusion due to hemorrhage.There was no case of conversion to open surgery or radical nephrectomy.The operation time was 50-140 min,with an average of(83.1±24.1)min,and the estimated intraoperative blood loss was 50-400 ml,averaging(125.0±93.1)ml.The postoperative exhaust time was 1-3 days,and the postoperative hospital stay was 3-7 days,with an average of 5.3 days.No serious postoperative complications occurred.Renal function was reexamined about one month after operation.Preoperative serum creatinine was 52-138 mmol/L,with an average of(72.1±22.7)mmol/L,and postoperative serum creatinine was 55-172 mmol/L,with an average of(81.5±28.2)mmol/L,with no significant difference(P>0.05).Postoperative pathological results:13 cases of clear cell carcinoma,1 case of chromophobe cell carcinoma,1 case of papillary renal cell carcinoma and 1 case of epithelioid hamartoma.During the follow-up period of 3-18 months no recurrence or metastasis was found.Conclusion:Dual-wavelength laser-assisted retroperitoneal laparoscopic partial nephrectomy without clamping renal artery is a feasible treatment for small exogenous renal tumors and has achieved satisfactory results in renal function protection.