第12肋上小切口保留肾单位手术61例报告

Mini-flank supra-12th rib incision for open partial nephrectomy （report of 61 cases）

目的 探讨小切口保留肾单位手术的优点和可行性.方法 回顾性分析2005-2011年61例第12肋上小切口保留肾单位手术患者的资料.男35例,女26例;年龄24 ～ 72岁,平均41岁.均行B超及CT检查,23例行MR检查,10例行肾动脉CT血管造影检查.38例术前诊断为肾癌,14例为肾血管平滑肌脂肪瘤,6例为复杂性囊肿和/或重复肾,3例未能明确诊断病变性质.21例病变位于右肾,40例位于左肾;22例位于肾上极,21例位于肾下极,其余位于中部;病变均为单发,直径2.3～8.8 cm,平均3.2 cm.61例手术均行腰部经第12肋上切口,分离出肾动脉阻断.创面内可见的血管断端均以3-0微乔线“8”字缝合,2-0微乔线“U”或“8”形贯穿缝合创面.结果 手术切口长度6.5 ～ 11.0 cm,平均8.1 cm;手术时间70～140 min,平均93 min;热缺血时间12～ 32 min,平均19 min;术中出血量20～300ml,平均72 ml;术后住院时间5～15 d,平均6d.1例患者术后第5天发生迟发性出血,经保守治疗后好转.病理结果：肾透明细胞癌28例,肾嫌色细胞癌6例,乳头状肾细胞癌5例,肾血管平滑肌脂肪瘤16例,肾（复杂性）囊肿3例,重复肾3例.45例获随访,其中35例恶性肾肿瘤患者随访36～82个月,未见复发和转移.结论 小切口保留肾单位手术创伤较小,手术过程可以完全复制传统开放手术,较小的切口也足以取出标本.小切口保留肾单位手术综合了开放和腹腔镜下保留肾单位手术的部分优点,可以在有效切除病变的基础上减少手术创伤.

Objective To report our experience of nephron sparing surgery （NSS） with mini-incision approach.Methods Sixty-one mini-incision NSS were analyzed retrospectively from 2005 to 2011 in our department.Demographic and clinical data,complications,histologic and oncologic data were analyzed.There were 35 males and 26 females with average age of 41 years.B ultrasound and CT scan were performed in all cases and MR was performed in 23 cases.CT angiography was performed in 10 cases.Renal cell cancer was diagnosed in 38 cases,angiomyolipoma in 14 cases,complicated renal cyst or duplicated kidney in 6 cases and no definite diagnosis in 3 cases.All the lesions were single with 21 in the right side and 40 in the left side.The average diameter of the lesions was 3.2 （2.3-8.8） cm.The mini-flank supra-12th rib incision was performed in all cases.The renal artery was clamped with bulldog clamp,all transected blood vessels on the renal incisal surface were sutured with 3-0 Vicryl sutures,and collecting system was closed with continuous＇ 3-0 Vicryl suture.Results The average length of incision was 8.1 （6.5-11.0） cm.The average operative time was 93 （70-140） min.The average warm ischemia time was 19 （12-32） min.The average blood loss was 72 （20-300） ml and the average hospital stay was 6 （5-15） d.The delayed hemorrhage was occurred in 1 patient who was treated with conservative treatment.Clear cell carcinoma was found in 28 cases,chromophobe carcinoma was found in 6 cases,papillary carcinoma was found in 5 cases,angiomyolipoma was found in 16 cases,complicated cyst was found in 3 cases and renal duplication was found in 3 cases.Fortyfive patients were followed up from 28 to 82 months with no delayed complication and no recurrence or metastasis in 35 malignant cases.Conclusions The approach of mini-incision NSS can duplicate the procedure of traditional open NSS.This approach can also couple the benefits of both laparoscopic and open NSS techniques with a smaller incision which can be used to remove the specimen.