经脐单孔腹腔镜肾部分切除术治疗T_(1a)期肾癌10例报告

Transumbilical Laparoendoscopic Single-site Partial Nephrectomy for the Treatment of T_(1a) Stage Renal Cell Carcinoma:Report of 10 Cases

目的：探讨经脐单孔腹腔镜肾部分切除术（ laparoendoscopic single-site partial nephrectomy ，LESS-PN）治疗早期肾癌的疗效和安全性。方法2012年11月～2014年2月对10例早期肾癌（T1aN0M0）应用自制单孔多通道套管行经脐单孔腹腔镜肾肿瘤部分切除术，阻断肾动脉并计时，距肿瘤边缘1 cm处切除，缝合肾实质，恢复肾血流。结果10例手术均获成功，肾脏热缺血时间平均19．7 min（15～30 min），手术时间平均93．9 min（80～120 min），术中出血量平均96．4 ml（30～180 ml），术中无输血。术后住院平均7．5 d（7～12 d）。术后病理肿瘤切缘均阴性。术后无尿漏、继发出血、感染等并发症。10例术后平均随访12个月（8～16个月），均无瘤生存，未见局部复发及转移。结论 LESS-PN治疗早期肾肿瘤安全可行，但技术要求较高，操作难度较大，需要积累丰富的经验。

Objective To investigate the efficacy and safety of transumbilical laparoendoscopic single -site partial nephrectomy （LESS-PN） for the treatment of early stage stage renal cell carcinoma . Methods From November 2012 to February 2014, transumbilical LESS-PN was used for the treatment of 10 cases of T1a stage renal cell carcinoma （T1aN0M0）.The renal artery was blocked when started the time .The tumor was resected with 1 cm margins .Then all the layers of the renal cortex were sutured and the renal blood flow was restored . Results The operations were successful in all the 10 cases.The time of renal warm ischemia was 19.7 min （range, 15-30 min）, the operation time was 93.9 min （range, 80-120 min）, and the blood loss was 96.4 ml （range, 30-180 ml）.No blood transfusion was required.The average hospitalization time was 7.5 d （range, 7-12 d）, and the pathological margin was negative .No urinary fistula , postoperative bleeding , infection or other complications occurred .During an average follow-up of 12 months （range,8 -16 months）, all the patients survived tumor free, without local recurrence and metastasis. Conclusion The transumbilical LESS-PN is feasible and safe in the treatment of early stage renal tumor , but the technical requirements are higher and the operation is more difficult , which needs a wealth of experience .