无缺血状态下的后腹腔镜肿瘤剜除术治疗肾错构瘤

Zero ischemia retroperitoneal laparoscopic enucleation for renal angiomyolipoma

目的：探讨低侵袭性的、彻底的肾错构瘤治疗方式,评估无缺血状态下的后腹腔镜肿瘤剜除术治疗肾错构瘤的疗效。方法：从2013年11月-2014年9月,我们采用介入栓塞联合后腹腔镜技术,术中无需阻断肾动脉,使用超声刀、吸引器等设备对7例术前影像学明确诊断为肾错构瘤的患者行肿瘤剜除术。肿瘤平均直径（4.1±1.0）cm。有2例患者因错构瘤破裂出血急诊入院。观察手术时间、术中出血量、术后住院时间、术中术后并发症及手术效果。结果：6例手术获得成功,1例肾错构瘤破裂出血患者,保守治疗时间较长,血肿机化,粘连较重,中转开放手术。6例患者平均手术时间（70.0±27.2）min,平均出血量（55.0±34.3）ml。术后随访2-12个月,无肿瘤复发。结论：后腹腔镜联合介入栓塞行肾错构瘤剜除术安全可行,具有创伤小、并发症少、恢复快、住院时间短等优点。

Objective： To explore minimally invasive and complete treatment of renal angiomyolipoma and to assess the efficacy of retroperitoneal laparoscopic nephron-sparing surgery for treating renal angiomyolipoma. Method.. From November 2013 to September 2014, seven patients with renal angiomyolipoma underwent enucleation through retroperitoneal laparoscopic surgery. Two of them were admitted to hospital emergently because of rupture of renal angiomyolipoma. Mean tumor size was （4. 1± 1.0） cm. The surgical techniques involved Harmonic Scalpel and aspirator. The operative time, blood loss, postoperative hospital stay, perioperative complications and operative effect were evaluated. Result： The procedures were successful in six patients. One emergency case was converted to open surgery because of organized hematoma. The mean operative time was （70.0±27.2） min and mean blood loss was （55.0±34.3） ml in six laparoscopic surgery patients. No tumor recurrence was found during follow-up period of 2-12 months. Conclusion： Retroperitoneal laparoscopic enueleation combined with interventional embolization is feasible and safe for renal angiomyolipoma. This procedure has the advantages of minimal invasion, few complications and short convalescence.