腹膜后腹腔镜肾部分切除术治疗巨大肾肿瘤的手术经验探讨

Retroperitoneal laparoscopic partial nephrectomy for giant renal tumor-surgery experience of a single center

目的:探讨腹膜后腹腔镜肾部分切除术治疗巨大肾肿瘤的手术经验及技巧。方法:回顾分析为5例巨大肾肿瘤患者行肾部分切除术的临床资料,观察手术成功率、手术时间、肾动脉阻断时间、术中出血量、术后引流量、术后下床活动时间、术后住院时间、短期并发症、患肾功能恢复等情况。结果:5例手术均获成功,无中转开放手术或行根治性切除术,中位手术时间105.0(90.0~115.0)min,中位肾动脉阻断时间29.0(25.0~31.0)min,术中出血量150.0(110.0~250.0)mL,术后引流量330(280~360)mL,术后下床活动时间3.0(3.0~4.0)d,术后住院时间8.0(7.0~9.0)d。术后3~6个月肾小球滤过率提示肾脏血供良好,无明显肾功能损害等异常。结论:腹膜后腹腔镜巨大肾肿瘤切除术是安全、可行的,术中沿包膜完整切除肿瘤、紧密缝合集合系统及应用分层免打结缝合、"2+1"缝合法是达到肿瘤切缘阴性、缩短热缺血时间、避免术后并发症的关键。

Objective:To explore the experience and skills of retroperitoneal laparoscopic partial nephrectomy for giant renal tumor.Methods:A retrospective analysis was made on the clinical data of 5 patients who suffered from giant renal tumors and underwent retroperitoneal laparoscopic partial nephrectomy.The clinical data included operation success rate,operation time,renal artery clamping time,intraoperative blood loss,postoperative surgical drainage,ambulation time,hospital stay,short-term complications,recovery of renal function and so on.Results:The successful rate of operation was 100%without conversion to open surgery or radical nephrectomy.The median operative time was 105.0(90.0-115.0)min,median renal artery clamping time was 29.0(25.0-31.0)min,median intraoperative blood loss was 150.0(110.0-250.0)mL,the median postoperative drainage volume was 330(280-360)mL,median ambulation time was 3.0(3.0-4.0)d,the median postoperative hospital stay was 8.0(7.0-9.0)d.After follow-up of 3-6 months,glomerular filtration rate showed good renal blood supply and no obvious abnormal renal function.Conclusions:Retroperitoneal laparoscopic partial nephrectomy for giant renal tumor is safe and feasible.The key to negative margin,reduced warm ischemia time and avoiding postoperative complications is resection of tumor along its envelope,close suture of the renal collecting systems,application of the delamination suture without knot and"2+1"suture method during the operation.