后腹腔镜下保留肾单位手术治疗T_1期肾癌的临床体会(附37例报告)

Retroperitoneal laparoscopic partial nephrectomy for T_1 renalcell carcinoma( report of 37 cases)

目的:探讨后腹腔镜保留肾单位手术(retroperitoneal laparoscopic partial nephrectomy,RLPN)治疗T1期肾癌的手术方法及临床效果。方法:回顾性分析37例行RLPN的T1期肾癌患者的临床资料,观察手术时间、术后住院时间、阻断方式及时间、术中出血和术后并发症及术后效果。结果:37例患者手术均顺利完成。手术时间62-185min,平均手术时间97min;肾动脉阻断时间0-47min,平均23.8min;出血量45-220ml,平均103.3ml;术中无并发症;术中切缘组织病理均阴性;术后无尿漏、继发出血及肾功不全发生;术后5天1例患者出现上消化道出血;平均住院日9天。随访时间3-48个月,平均24个月,复查B超及CT未见肿瘤复发及转移;复查静脉肾盂造影(IVP)提示患侧肾肾功能良好。结论:RLPN安全有效、创伤较小、出血少、恢复快,同时可保留患肾功能,可作为治疗T1期肾癌的首选手术方式。

Objective：To evaluate the clinical experience of retroperitoneal laparoscopic partial nephrectomy （ RLPN）in the treatment of T1 renalcell carcinoma. Methods：RLPN was performed in 37 cases with T1 renalcell car-cinoma. Operation time,postoperative hospital staytime,the way and time of blocking,blood lose,postoperative compli-cations and effect were observed. Results：RLPN was performed in the 37 cases successfully. The meanoperation time was 97min（62-185min）. The mean renal artery blood flow occlusiontime was 23. 8（0-47）min. The mean blood lose was 103. 3（45-220）ml. There was no intraoperative suigical complications. Intraoperative pathological margins were negative. There were no complications such as leakage of urine,secondary bleeding,renal insufficiency was oc-curred. 5 days after operation,1 patient had upper gastrointestinal bleeding. The mean hospital stay was 9d. During 24 （3-48）months of following up,there was no recurrence and metastasis,and no case was observed to have functional loss of the remaining kidney on intravenous urography. Conclusion：RLPN is safe,effective,mini-invasive,quicker recovery,meanwhile,renal function is maximally reserved,can be used as the preferred mode of operation treatment of stage T1 renal cell carcinoma.