肾周脂肪粘连时行腹腔镜肾部分切除术的初步经验

Preliminary experience of laparoscopic partial nephrectomy in patients with adherent perinephric fat

目的探讨肾周脂肪粘连情况下行腹腔镜下肾部分切除术的初步经验。方法回顾性分析2016年1月至12月第二军医大学长海医院泌尿外科单术者收治的16例肾周脂肪粘连、接受腹腔镜下肾部分切除术患者的临床资料。肾周脂肪组织与肾包膜粘连严重者,显露肿瘤与正常肾组织的大概边界后,可通过术中B超辅助肿瘤定位,然后用电刀标记肿瘤大概边界。阻断血流后,用组织剪沿标记线将粘连的脂肪组织和肿瘤一起切除。结果 16例患者均顺利完成手术,5例肾周脂肪粘连严重者术中使用B超定位。肿瘤最大径为2.1~3.5(2.8±0.4)cm,梅奥粘连概率(MAP)评分为3~5(3.8±0.7)分,肾动脉阻断时间为20~31(25.6±3.1)min,手术时间为90~133(112.0±10.5)min。随访时间为6~20个月,随访期内未见肿瘤复发转移。结论肾周脂肪粘连情况下行腹腔镜下肾部分切除术的术中肿瘤边界定位非常重要,必要时可借助术中B超。有必要将肿瘤和粘连的脂肪组织一起切除,但切忌强行分离脂肪,撕裂肾包膜。

Objective To investigate the preliminary experience of laparoscopic partial nephrectomy in patients with adherent perinephric fat. Methods We retrospectively analyzed the clinical data of 16 patients with adherent perinephric fat undergoing laparoscopic partial nephrectomy by the single surgeon in the Department of Urology of Changhai Hospital, Second Military Medical University between Jan. 2016 and Dec. 2016. For the patients with serious adherent perinephric fat, the tumor could be located by the intra-operative B-mode ultrasound after exposing the general boundaries of tumor and normal renal tissues, and the boundaries were marked with electric knife. The adherent adipose tissue and tumor were both resected with scissors along the marking line after blocking the blood flow. Results The operations were successfully completed in all the 16 patients, and the intra-operative B-mode ultrasound positioning was used in 5 cases. The maximal diameter of tumor was 2.1-3.5（2.8±0.4） cm, the Mayo adhesive probability（MAP） score was 3-5（3.8±0.7）, the renal artery occlusion time was 20-31（25.6±3.1） min, and the operation time was 90-133（112.0±10.5） min. During a follow-up of 6-20 months, no patients had recurrence or metastasis. Conclusion It is important to locate the tumor boundaries during laparoscopic partial nephrectomy in patients with adherent perinephric fat, and the intra-operative B-mode ultrasound can be used if necessary. The tumor and adherent adipose tissue must be both resected to avoid forced separation of perirenal fat from renal capsule.