后腹腔镜肾肿瘤单纯剜除术及切除剜除方式在T_1期肾癌的应用(附97例报告)

Clinical application of retroperitoneal laparoscopic simple enucleation and combination of resection and enucleation on T1renal tumor(Report of 97 cases)

目的:介绍后腹腔镜下单纯剜除及切除剜除方式治疗T1期局限性肾癌的临床经验。方法:回顾性分析2005~2016年我院采取后腹腔镜下单纯肾癌剜除术(retro laparoscopic simple enucleation;rLSE)及切除与剜除相结合方式治疗T1期局限性肾癌97例的临床资料,其中采取rLSE组37例,采取切除剜除组60例。分析所有患者手术时间、术中出血量、肾脏热缺血时间及肿瘤控制情况。结果:97例手术顺利完成,所有病例均行肾动脉阻断,无中转开放。rLSE组和切除剜除组:平均手术时间分别为86.83(80~120)min和88.36(70~140)min;平均热缺血时间(WIT)分别为19.82(14~27)min和25.84(13~28)min;术中出血量分别为55.75(40~90)ml和78.47(50~150)ml。rLSE组术中均无集合系统损伤,行单层肾脏缝合。切除剜除组术中有1例损伤集合系统,给予双层肾脏缝合。两组均无肾蒂血管损伤,术后均无尿瘘及动静脉瘘。中位随访29.6(4~58)个月,术后均无局部复发及远处转移。结论:由于早期局限性肾癌假包膜的存在及其完整性,使得腹腔镜下单纯肾肿瘤剜除术及切除剜除方式在治疗早期局限性肾癌上技术可行,其肿瘤学预后可靠。当肿瘤直径较大时,除非在迫切需要保留肾单位或肾肿瘤评分较低的病例中选择性应用该项技术。

Objective：To discuss the technique and clinical efficacy of retroperitoneal laparoscopic simple enucleation and combination of resection and enucleation for treating localized T1 renal carcinoma.Method：We summarized and analyzed the clinical data of 97 cases who underwent retroperitoneal laparoscopic simple enucleation and combination of resection and enucleation of renal tumor at our hospital.Thirty-seven cases were executed retroperitoneal laparoscopic simple enucleation,while 60 cases were executed via the way of combination of resection and enucleation.Result：All the cases were performed smoothly with renal artery occlusion.Mean operative time undergoing retroperitoneal laparoscopic simple enucleation and combination of resection and enucleation were 86.83（80-120）min and 88.36（70-140）min.Mean warm ischemia time were 19.82（14-27）min and 25.84（13-28）min.Mean blood loss were 55.75（40-90）ml and 78.47（50-150）ml.No operative complications occurred in retroperitoneal laparoscopic simple enucleation group,while there was one cellecting system injury in combination of resection and enucleation.No urine leakages or arteriovenous fistula occurred in both groups.Overall,during the median follow-up period of 29.6（4-58）months,no local recurrence or distant metastasis occurred in all cases.Conclusion：Retroperitoneal laparoscopic simple enucleation of renal tumor is technically feasible as to the existance and integrity of pseudocapsule of renal tumor and it is oncologically effective.It should be advised that the enuclation shuold be carefully selected when the tumor size is bigger,but it is an alternative of radical nephrectomy when it is urgent to protect the renal function.