内生型肾癌行后腹腔镜肾部分切除术的安全性与有效性研究

目的：探讨内生型肾癌患者行后腹腔镜下肾部分切除术（LPN）的安全性与有效性。方法回顾性分析内生型肾癌行LPN术28例患者的临床资料，从手术情况、随访结果分析其安全性与有效性。结果28例患者手术均顺利完成，无中转开放手术，术后无严重并发症。手术时间（108.2±19.3）min，术中热缺血时间（15.5±4.3）min，术中出血量〈50ml。在不借助腹腔镜超声的前提下，按照肾脏分区、肿瘤与肾脏解剖关系，将肿瘤精确定位并完整切除。术后患者住院时间（4.1±0.9） d；随访（30.3±10.6）个月，术后6个月肾小球过滤率（eGFR）较术前差异无统计学意义；1例患者eGFR下降25%，术后肾功能长期维持在CKD2期，其余患者未出现急、慢性肾功能不全，未行肾、腹膜透析等替代治疗；随访期间28例患者均未见肿瘤局部复发及远处转移。结论 LPN术治疗内生型肾癌可行、安全、有效，但尚需大样本研究及随访观察远期疗效。

ObjectiveTo study retroperitoneal laparoscopic partial nephrectomy techniques in patients with endophytic renal cell carcinoma（RCC）,especially tumor location and excision techniques,and evaluate its the safety and effectiveness. MethodsFrom May 2007 to June 2013,28 cases（17 males and 11 females）of endophytic RCC patients were retrospectively analyzed. Mean age was（45.6±4.9）years,mean tumor size was（2.1±0.4）cm in diameter,with 13 cases on the left side and 15 cases on the right side. Preoperative imaging examinations showed less than 40% of the renal tumor extending off the surface of the kidney,and eight cases of renal tumors were completely endophytic. All of the 28 patients received retroperitoneal laparoscopic partial nephrectomy.Results28 cases were operated successfully without conversion to open surgery,no severe perioperative complications. The mean operation time was（108.2±19.3）min,and mean warm ischemia time（WIT）was（15.5±4.3）min,and mean blood loss was less than 50 ml; Without the help of laparoscopic ultrasound,with the experience of the surgeon,kidney partition,and the anatomical relationship between the tumor and kidney,the tumor was precisely positioned and complete resection. Mean postoperative hospital stay was（4.1±0.9）days. In a mean follow up for（30.3±10.6）months,estimated glomerular filtration rate（eGFR）6 months after operation was no statistical significance compared with preoperation in 28 cases except one patient’s eGFR decreased by 25%,and Postoperative renal function remained in CKD2 period. The remaining patients with normal renal function after surgery, and none of 28 cases were treated with hemodialysis. During the follow-up period,no tumor recurrence and metastasis occurs. ConclusionsRetroperitoneal laparoscopic partial nephrectomy is safe,effective and feasible for select patients with endophytic renal tumors,including tumor with completely endophytic characteristic. But its long-term effects still need to study with large samples prospective controlled study and long-term follow-up.