后腹腔镜肾部分切除术治疗偶发肾癌的临床分析

Clinical analysis of retroperitoneal laparoscopic partial nephrectomy on patient with incidental renal cell carcinoma

目的探讨后腹腔镜肾部分切除术治疗偶发肾癌的安全性和临床效果。方法回顾性分析2011年12月至2013年10月26例采用后腹腔镜肾部分切除术治疗的T1期偶发肾癌患者的临床资料，观察手术时间、热缺血时间、术中出血量、围手术期并发症及预后。结果26例手术均顺利完成，无中转开放手术或更改术式者。手术时间为90—190min。26例均单纯阻断肾动脉，热缺血时间为15～30min。术中失血量100—360ml。术后引流管留置时间3～7d，住院时间7—12d。术后病理检查均为肾透明细胞癌，切缘均为阴性。术后无出血、感染、漏尿等并发症。随访3—25个月均无瘤生存，未见肿瘤复发及远处转移。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T1期偶发肾癌安全可行，创伤小、恢复快、保留肾单位功能恢复良好，值得推广应用。

Objective To evaluate the safety and clinical efficacy of retroperitoneal laparoscopic partial nephrectomy （LPN） in patients with incidental renal cell carcinoma. Methods Twenty-six patients with T1 incidental renal cell carcinoma treated with retroperitoneal LPN from Dec. 2011 to Oct. 2013 were analyzed retrospectively. The operation time, warm ischemia time, intraoperative blood loss, complications and prognosis of perioperative periods were collected. Results All 26 cases were operated successfully without conversion to open or other surgery. The operation period was 90 - 190 minutes. Blockage of renal artery was applied in all 26 cases, and the warm ischemia time was 15 -30 minutes. The intraoperative blood loss was 100 -360 ml. The drainage was removed 3 -7 days postoperatively, and the hospitalization period was 7 - 12 days. All cases were clear cell renal cell carcinoma by pathological examinations, and showed negative surgical margins. No complications such as postoperative bleeding, inflammation and leakage of urine were occurred. All cases had normal renal function during the follow-up of 3 - 25 months without local recurrence or distant metastasis. Conclusion Retroperitoneal LPN for the treatment of T1 incidental renal cell carcinoma is worthy of application with the advantages of safety, minimal invasiveness, fewer complications, quick recovery and good nephron-sparing functional recovery.