后腹腔镜下零缺血免缝合肿瘤吸除术治疗巨大肾错构瘤3例报告

Retroperitoneal laparoscopic tumor aspiration for huge renal angiomyolipoma using zero-ischemia and sutureless technique:report of 3 cases

目的:探讨后腹腔镜下零缺血免缝合肿瘤吸除术治疗巨大肾错构瘤的安全性及可行性。方法:2018年4月~2019年6月我院应用后腹腔镜下零缺血免缝合肿瘤吸除术治疗3例巨大肾错构瘤。患者年龄分别为45岁、42岁、60岁,BMI分别为25.8kg/m^2、20.4kg/m^2、18.4kg/m^2。术前均通过彩超和CT等相关检查确诊为巨大肾错构瘤。全麻。于后腹腔镜下游离出肾动脉,以备必要时阻断。游离肾脏肿瘤,将吸引器深入瘤体进行抽吸,用超声刀切除肿瘤包膜及基底部组织,手术创面采用单极电凝Spray模式充分止血,对于难以吸除的成形瘤体装入标本袋取出。结果:3例手术均未阻断肾动脉,顺利完成。手术时间分别为90min、100min、125min,估计出血量分别为300mL、700mL、700mL。1例患者术后接受输血治疗。术后住院时间分别为4d、7d、7d。无术后继发出血及尿漏等并发症发生。结论:后腹腔镜下零缺血免缝合肿瘤吸除术治疗巨大肾错构瘤安全可行,值得临床应用。

Objective:To investigate the safety and feasibility of retroperitoneal laparoscopic tumor aspiration with zero-ischemia and sutureless technique in the treatment of huge renal angiomyolipoma.Method:From April 2018to June 2019,three patients with huge renal angiomyolipoma were treated by retroperitoneal laparoscopic tumor aspiration with zero-ischemia and sutureless technique.The patients were 42,45and 60years old,with body mass index of 20.4,25.8and 18.4kg/m^2,respectively.The patients were diagnosed as giant renal angiomyolipoma by color doppler ultrasound and computer tomography before the operation.Under the general anesthesia,the renal artery was dissociated under retroperitoneal laparoscopy to block if necessary.The tumor was dissociated and then aspirated with an aspirator.The capsule and basal tissue of the tumor were removed with harmonic scalpel.The surgical wound was treated with a unipolar electrocoagulation in spray mode to fully stop the bleeding.The formed tumor that was difficult to be aspirated was put into a specimen bag and removed.Result:All 3cases were successfully completed without blocking the renal artery.The operation time was 90min,100min and 125 min,and the estimated blood loss was 300mL,700mL and 700mL,respectively.One patient received blood transfusion after the surgery.The postoperative hospital stay was 4d,7dand 7d,respectively.No postoperative complications such as secondary bleeding or urine leakage occurred.Conclusion:It is safe and feasible to treat huge renal angiomyolipoma by retroperitoneal laparoscopic tumor aspiration with zero-ischemia and sutureless technique.And it is worthy of clinical application.