腔内超声引导下腹腔镜肾部分切除术治疗完全肾内型肾肿瘤5例报告

Laparoscopic partial nephrectomy for completely intraparenchymal renal tumors under intracavitary ultrasound guidance:report of five cases

目的：探讨腹腔镜肾部分切除术治疗完全肾内型肾肿瘤的手术技巧及结果。方法：2008年9月~2013年8月采用腹腔镜下肾部分切除术治疗完全型肾肿瘤患者5例,其中肾透明细胞癌4例,肾错构瘤1例;经腹膜后腔途径4例,经腹腔途径1例。手术的关键步骤包括术中超声的应用、肾蒂的阻断和肾脏集合系统的缝合等。结果：5例患者手术均顺利完成,平均手术时间180（135~250）min,肾蒂阻断时间22~40min,平均33min。肿瘤大小平均2.3（1.5~3.0）cm,术中平均出血量180（100~250）ml,均未输血,术中需集合系统修补4例。术后随访5~55个月,平均35.3个月,均未见肿瘤局部复发或远处转移。结论：腹腔镜肾部分切除术治疗完全肾内型肾肿瘤安全有效,术中超声检查可对肿瘤进行有效定位,减少切缘的阳性率,是手术成功的关键。

Objective：To describe our technique and results of laparoscopic partial nephrectomy（LPN）for completely intraparenchymal renal tumors under intracavitary ultrasound guidance.Method：From September 2008 to August 2013,we identified five patients who had undergone LPN for completely intraparenchymal renal tumors including four cases of clear cell carcinoma of kidney and one case of renal angiomyolipoma.Four of them were done by retroperitoneal approach and one was done by transperitoneal approach.Operation steps included intraoperative ultrasound guidance of tumor resection,interruption of renal pedicle,and suturing of collecting system.Result：Laparoscopic surgery was successful in all cases without any open conversions.The mean operating time and warm ischemia time were 180（range,135-250）minutes and 33（range,22-40）minutes,respectively.The mean tumor size was 2.3（range,1.5-3.0）cm.The pelvicaliceal system was entered and repaired in four patients（80%）,and the median estimated blood loss was 180（range,100-250）ml.None of them needed intraoperative or postoperative blood transfusion.During a mean follow-up of 35.3（range,5-55）months,no patient had evidence of local recurrence or metastatic disease.Conclusion：LPN for completely intraparenchymal renal tumors is a feasible and safe procedure.Laparoscopic ultrasound can be used to identify the tumor borders and depth which is the key to a successful procedure.