后腹腔镜下保留肾单位手术在T1b期肾肿瘤切除中的应用

The application of retroperitoneal laparoscopic nephron-sparing surgery in stage T1b renal cell carcinoma

目的探讨后腹腔镜下保留肾单位手术（NSS）在T1b期肾肿瘤中的可行性与安全性。方法回顾性分析2014年3月至2017年6月复旦大学附属中山医院和上海市闵行区中心医院泌尿外科实行后腹腔镜NSS手术的T1b期肾肿瘤患者共52例，其中男36例，女16例；肿瘤直径4.0～6.8（4.7±0.45）cm。统计患者的肿瘤解剖特点、手术时间、术中失血量、热缺血时间、并发症、住院时间及肿瘤控制情况。结果50例患者顺利完成腹腔镜手术，2例由于术中创面出血量多中转开放手术。50例腹腔镜手术时间100～220（122±20.86）min；术中出血量50～800（140±128.85）ml；热缺血时间25～42（30±3.52）min；手术前血肌酐65～148（100±23.54）μmol/L；手术后3个月血肌酐72～224（104±30.84）μmol/L，手术前后肾功能比较差异无统计学意义（P＝0.056）；术后伤口引流80～550（180±82.33）ml；术后住院时间5～15（8±1.56）d。1例患者术后6 d发生肺动脉栓塞，经保守治疗后好转。52例患者中50例获随访，其中47例恶性肾肿瘤患者随访3～29个月，2例发生肺部转移。结论T1b期肾肿瘤在对肿瘤进行详细的评估后，可以安全地实行后腹腔镜下NSS手术。

ObjectiveTo investigate the safety and feasibility of retroperitoneal laparoscopic nephron-sparing surgery （NSS） in stage T1b renal cell carcinoma （RCC） patients .MethodsBetween March 2014 and June 2017, 52 stage T1b RCC cases （36 males, 16 females） treated with retroperitoneal laparoscopic NSS in Zhongshan Hospital and Central Hospital of Minhang District were enrolled and retrospectively analyzed, with a tumor size range of 4.0 to 6.8 cm, and a mean size of（4.7±0.45）cm.The anatomic characteristics of tumors, operative time, intra-operative blood loss, warm ischemia time, intra- and post-operative complications, length of hospital stay, and oncological outcomes were reviewed.ResultsOnly 2 cases converted to open surgery due to uncontrollable bleeding in operation. The rest 50 cases successfully underwent retroperitoneal laparoscopic NSS, with mean operative time of （122±20.86） min （range： 100-220 min）, mean blood loss of （140±128.85）ml （range： 50-800 ml）, mean warm ischemia time of （30±3.52）min （range： 25-42 min）, pre-operative mean serum creatinine of （100±23.54）μmol/L （range： 65-148 μmol/L）, mean serum creatinine three monthsafter operation of （104±30.84）μmol/L （range： 72-224 μmol/L）, mean drainage of （180±82.33）ml （range： 80-550 ml）, mean length of hospital stay after operation of （8±1.56）d （range： 5-15 d）. There was no significant difference in renal function between pre- and post-operation （P=0.056）. One patient suffered pulmonary embolism was cured conservatively. Fifty patients were followed up, among which 47 cases with malignant pathology were followed up for 3-29 months, and two of them suffered from pulmonary metastasis.ConclusionsAfter pre-operative comprehensive assessment of tumors, stage T1b renal cell carcinoma could be treated with retroperitoneal laparoscopic NSS safely.