基层医院后腹腔镜肾部分切除术的临床经验(附15例报告)

Clinical Experience of Retroperitoneal Laparoscopic Partial Nephrectomy in Primary Hospital (Report of 15 cases)

目的探讨后腹腔镜肾部分切除术在基层医院的可行性及安全性。方法回顾性分析南京医科大学附属江宁医院泌尿外科2014年6月-2018年6月接受经后腹腔镜肾部分切除术15例患者的临床资料,其中男性7例,女性8例,年龄45~73岁,平均55.7岁,右侧肿瘤9例,左侧肿瘤6例,错构瘤4例,肾癌11例,神经内分泌瘤1例,恶性肿瘤切缘均阴性。结果15例患者后腹腔镜肾部分切除手术均获成功,无中转开放手术,手术时间100~210 min,肾动脉阻断时间平均27 min,术中出血50~300 mL,3例患者术后出血,其中2例输血治疗及保守治疗后恢复,术后住院时间7~18 d,平均12 d。术后病理错构瘤4例,肾癌10例,神经内分泌癌1例,恶性肿瘤切缘均阴性,随访6~54月,未见明显肾功能下降、肾萎缩及肿瘤复发转移。结论后腹腔镜肾部分切除术是泌尿外科高难度和复杂性技术,通过技能和标准操作流程的培训,在基层医院开展是安全有效的,有利于腹腔镜技术的推广应用。

Objective To investigate the feasibility and safety of retroperitoneal laparoscopic partial nephrectomy in primary hospitals.Methods The clinical data of retroperitoneal laparoscopic partial nephrectomy in our department were retrospectively analyzed from June 2014 to June 2018,including 7 males and 8 females,aged 45~73 years,with an average age of 55.7 years,9 right tumor cases,6 left tumor cases,4 hamartoma cases and 11 renal cancer cases.Results All 15 patients underwent laparoscopic partial nephrectomy successfully without conversion to open surgery.The operation time ranged from 100 minutes to 210 minutes,the average time of renal artery occlusion was 27 minutes.The intraoperative bleeding was 50~300 mL,and 3 patients had postoperative bleeding.Among them,2 patients recovered after transfusion and conservative treatment,and the hospital stay was 7~18 days,with an average of 12 days.Postoperative pathological showed that hamartoma was found in 4 cases,renal cell carcinoma in 10 cases and neuroendocrine carcinoma in 1 case.The margins of malignant tumors were all negative.Significant decrease in renal function,renal atrophy and recurrence and metastasis of tumors were no found in Follow-up within 6 to 54 months.Conclusion Retroperitoneal laparoscopic partial nephrectomy is a difficult and complex technique in urology.It is safe and effective to carry out retroperitoneal laparoscopic partial nephrectomy in primary hospitals through training of skills and standard operating procedures,which is conducive to the popularization and application of laparoscopic techniques.