腹腔镜肾部分切除术治疗完全内生型肾癌的临床疗效及手术技巧

Laparoscopic partial nephrectomy for complete endophytic renal cell carcinoma:clinical efficacy and surgical technique

目的:探讨完全内生型肾癌患者行腹腔镜下肾部分切除术(LPN)的临床疗效,总结手术技巧。方法:回顾性分析2013年5月至2016年6月收治的完全内生型肾癌行LPN的28例患者的资料,分析其手术特点及术前术后的临床资料。结果:所有患者术中均采用超声定位,其中5例肾动静脉同时阻断,26例术中进行了集合系统的修补。28例手术均顺利完成,平均手术时间(60±14.2)min,平均肾脏热缺血时间(25±4.6)min。术后6个月患肾肾小球滤过率(GFR)从术前的(47.6±4.1)mL/min降至术后的(37.0±3.9)mL/min,健侧肾脏GFR从(47.6±4.7)mL/min升高至(55.7±5.8)mL/min,差异均有统计学意义(P<0.05);总体肾功能和肌酐水平手术前后差异无统计学意义。结论:完全内生型肾癌腹腔镜肾部分切除术安全可行,肾脏功能可由健侧代偿,整体肾脏功能和肌酐水平维持正常。

Objective：To evaluate the clinical efficacy and surgical technique of laparoscopic partial nephrectomy （LPN） in patients with endophytic renal cell carcinoma （RCC）. Methods：The data of 28 patients who underwent LPN during May 2013 to June 2016 for RCC were retrospectively analyzed. The clinical data were collected before and after the operation. Results：During the operation, all the patients were operated successfully through laparoscopic ultrasonography to localize of the tumor. In 5 cases, the technique of simultaneous occlusion of the arteriovenous system was used, and the repair of the collection system was performed in 26 patients. The mean operation time was （60±14.2） min, mean renal warm ischemia time was （25±4.6） min. Six months after the operation the glomerular filtration rate （GFR） of ipsilateral kidney was decreased from preoperative （47.6±4.1） mL/min to postoperative （37.0±3.9） mL/min, and the GFR of contralateral kidney was increased from preoperative （47.6±4.7） mL/min to postoperative （55.7±5.8） mL/min, the differences were statistically significant. However, there was no statistical difference in overall renal function and serum creatinine before and after surgery. Conclusions：Laparoscopic partial nephrectomy for renal cell carcinoma is safe and effective. Although the renal function of the ipsilateral kidney is influenced, the overall renal function and creatinine level can be compensated by the contralateral side.