“拱形窗”技术在后腹腔镜肾脏部分切除术中的应用

Application of “arch window” technique in retroperitoneoscopic partial nephrectomy

目的 探讨“拱形窗”技术在后腹腔镜肾脏部分切除术中应用的有效性和安全性.方法 我院在128例后腹腔镜肾部分切除术中采用“拱形窗”技术,其中男76例,女52例.年龄31～76岁,平均54岁.肿瘤位于肾上极65例,中部31例,下极32例.肿瘤直径0.8～6.2 cm,平均2.6cm.术前按美国肿瘤联合委员会（AJCC）肾癌TNM肿瘤分期均为T1N0M0.结果 128例后腹腔镜肾部份切除术均顺利完成,无中转开放,术中未出现大血管或临近脏器损伤等严重并发症.术后并发症出现13例,包括血尿8例,皮下气肿2例,切口延迟愈合3例,其中血尿患者经相关保守处理后痊愈.手术时间55 ～ 186 min,平均89 min.术中出血量30 ～ 220 ml,平均60 ml,术中均未输血.肾动脉阻断时间14 ～ 35 min,平均22 min.术后病理报告肾透明细胞癌106例,乳头状细胞癌1例,切缘均为阴性;血管平滑肌脂肪瘤21例.术后随访1 ～ 25个月,平均18个月,未发现肿瘤复发或远处转移,肾功能正常.结论 “拱形窗”技术在后腹腔镜肾脏部分切除术中的应用安全可行,具有术野暴露充分、方便手术操作等优点.

Objective To investigate the feasibility of the ＂arch window＂ technique in retroperitoneoscopic partial nephrectomy.Methods The ＂arch window＂ technique was performed on 128 renal carcinoma patients receiving retroperitoneoscopic partial nephrectomy between June 2012 and June 2014.There were 76 males and 52 females,with age ranging between 31-76 （average 54）.The tumors were all at T1N0M0 stage of American Joint Committee on Cancer （AJCC） with diameters of 0.8-6.2 cm （average 2.6 cm） and located in the upper pole,middle,and lower pole of the kidney in 65,31 and 32 cases respectively.Medical data were collected and compared with the same practice performed without using arch window technique from April 2010 to May 2012.Results All 128 operations were successful without conversion to open surgery.There were no serious intraoperative complications such as damaged large blood vessels or adjacent organs.Thirteen patients had postoperative complications,including 8 cases of hematuresis,2 cases of subcutaneous emphysema and 3 cases of delayed healing.Three hematuria patients recovered after conservative treatment.The operation time was 55-186 min （average 89 min）,and blood loss was 30-220 ml （average 60 ml）.No patient needed intraoperative blood transfusion.The average renal artery occlusion time was 22 min （14-35 min）.Pathological examination reported 106 renal clear cell carcinomas and 1 papillary carcinoma with negative margin; and 21 renal angiomyolipomas.Patients were followed up for 1-25 months post-operation （average 18 months）.There was no tumor recurrence or distant metastasis and renal functions were normal.Arch window group had significantly shorter suture time,operation time and renal warm ischemia time,and less intraoperative bleeding than non-arch window group.Conclusion The use of ＂arch window＂ technique in retroperitoneoscopic partial nephrectomy is safe and feasible.It benefits from sufficient surgery field exposure and convenient operation and is worthy of wider clinical application.