肾脏旋转在后腹腔镜肾脏部分切除术中的应用

The application of the renal rotation technique in retroperitoneoscopic partial nephrectomy

目的 探讨肾脏旋转在后腹腔镜肾脏部分切除术中应用的有效性和可行性.方法 我院行后腹腔镜肾部分切除术中采用肾脏旋转方法切除肾脏腹侧、肾门部以及肾脏下极肿瘤38例,肿瘤位于肾脏腹侧29例（其中肾门部22例）,肾脏下极9例.肿瘤直径1.5 -4.6 cm,平均2.8cm.术前按美国肿瘤联合委员会（AJCC）肾癌TNM肿瘤分期均为T1No Mo.结果 38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.术后发生并发症3例,包括血尿1例,皮下气肿2例,其中血尿患者经保守处理后痊愈.术后随访1 - 26个月,平均17个月,未发现肿瘤复发或远处转移.结论 肾脏旋转用于后腹腔镜肾脏部分切除术是安全可行的,对于后腹腔暴露不佳的肾内侧（包括肾门处肿瘤）以及部分肾下极肿瘤具有术野暴露充分、方便手术操作等优点.

Objective Introduction Retroperitoneoscopic partial nephrectomy （RPN） is one of the standard methods for treating T1 stage renal carcinoma which suffers from narrow operation space and difficultly in operation.Our aim is to investigate the safety and feasibility of renal rotation technique in RPN.Methods Between April 2012 and June 2014,the renal rotation technique in RPN was performed in 22 male and 16 female patients with stage T1N0M0 renal cell carcinoma aged 31-75 years （mean 52）.In 29 cases tumor located in ventral side of kidney,including 22 cases in the renal hilum and 9 cases in inferior pole of kidney.Tumor size was 1.5-4.6 cm,mean 2.8 cm.Results All the 38 cases of operations were successfully accomplished without conversion to open surgery.There were no intraoperative complications and 3 cases postoperative complications.Operation time was 45-116 min,mean 59 min; blood loss was 20-120 ml,mean 40 ml,with no patients needed blood transfusion.The average kidney ischemia time was 21 min （15-38 min）.No patients had local recurrence or metastasis after 1-26 months＇ follow-up.Conclusion Application of the renal rotation technique in RPN for tumors located at ventral side,at renal hilum,or at the inferior pole of kidney,is safe and feasible,and worth wider clinical application.