后腹腔镜下零缺血时间行保留肾单位肾脏肿瘤切除术

Retroperitoneal laparoscopic nephron-sparing surgery with zero ischemia

目的探讨后腹腔镜下不阻断肾动脉行保留肾单位肾脏肿瘤切除术的手术方法可行性及安全性,减少后腹腔镜下保留肾单位手术对肾脏功能的影响。方法对16例〈4 cm的肾脏周边型肿瘤行后腹腔镜下不阻断肾动脉方法保留肾单位肾脏肿瘤切除术。建立传统四通道后腹腔腔隙,寻找并游离肾动脉不予阻断,充分游离整个肾脏并暴露肿瘤,于肿瘤边缘0.3-0.5 cm用剪刀开始切除肿瘤,遇可疑血管及活动出血用双极电凝（PK刀）止血,助手用吸引器保持创面清晰;完整切除肿瘤后用结扎夹代替打结的方法连续缝合创面,最后创面喷洒生物蛋白凝胶。结果 14例手术取得成功,2例因出血难以控制采用暂时阻断肾动脉后完成手术,无中转开放。手术时间65-150 min,平均86 min;出血量50-550 ml,平均240 ml;术后住院时间7-10 d,平均9 d;术后无肾脏继发出血、漏尿等外科并发症。结论后腹腔镜下不阻断肾动脉行保留肾单位肾脏肿瘤切除术对肾周表浅T1a期肿瘤安全可行,有较好的临床应用价值。

Objective To evaluate the feasibility and safety of one kind of renal tumorectomy with retroperitoneal laparoscopy which was a nephron-sparing surgery without blocking the renal artery. Methods16 renal peripheral tumors less than 4cm were treated with tumorectomy. Firstly, traditional four tunnels in retroperitoneum were established; Secondly, renal artery was located and dissociated without ligation and fully exposure of the tumor; After then, the tumor was removed with scissors at the outsides of tumor（0.3-0.5cm）; In case of bleeding, bipolar electrocoagulation（PK knife） was used; Wound surface was kept clear by an assistant suction device; Finally, wound surface was continuously sutured with the method of clamping instead of ligature after tumor was completely resected; Biological protein gel was sprayed at the wound surface. Results In all 16 patients, the procedures were done without conversion to open surgeries.14 cases were succeed without any hold-up; While the renal artery of the other 2 was temporarily blocked in the surgery due to hemorrhage. The mean operation time was 86 min（65-150 min）, the mean blood loss was 240ml（50-550 ml）, the mean post-operative hospital stay was 9 d（7-10 d）. Complications such as renal hemorrhage and urine leakage were noticed after surgery. Conclusion The renal tumorectomy described in this article is safe and feasible for patients with superficial T1 a renal tumor, and has good clinical application value.