经肠系膜途径腹腔镜左肾部分切除术7例报告

Transmesocolic laparoscopic partial nephrectomy:a report of 7 cases

目的探讨经肠系膜途径腹腔镜下肾部分切除术(LPN)治疗肾占位的操作技巧及可行性。方法回顾性分析2019年1~10月间我科完成的7例经肠系膜途径左侧LPN患者的临床资料。患者无临床症状,均系体检发现。占位均位于左侧肾脏腹侧面,直径2.2~5.2 cm,R.E.N.A.L.评分4~6分。手术采用改良健侧卧位经腹途径,离断Treitz韧带,平行肠系膜下静脉切开降结肠系膜表面并扩大切口。继续游离左肾,完成肾部分切除后关闭肠系膜切口。结果手术均顺利完成,手术时间80~120 min,术中出血量10~100 ml,热缺血时间8~18 min。无输血、漏尿、假性动脉瘤形成等并发症。结论经肠系膜途径具有减少创伤、加速术后康复等优点,是经腹左肾LPN的可选入路,特别适用于腹侧肿瘤。

Objective To evaluate the feasibility of transmesocolic laparoscopic partial nephrectomy(LPN)for renal tumor on the left side.Methods The clinical data of 7 patients receiving left transmesocolic LPN in our department from January to October 2019 were retrospectively analyzed.The diagnoses were confirmed after physical examination without obvious symptoms.All lesions were located in the ventral side of left kidney,with diameter of 2.2-5.2 cm and R.E.N.A.L.score of 4-6.The transmesocolic approach was achieved under modified lateral position to the healthy side.Treitz ligament was divided before incision of descending mesocolon being expanded paralleling the inferior mesenteric vein.The kidney was then mobilized,and the mesenteric incision was closed after partial nephrectomy being completed.Results The surgeries were completed successfully with the operation time of 80-120 min,and the intraoperative blood loss of 10-100 ml,as well as the warm ischemia time of 8-18 min.No complication has happened including blood transfusion,leakage of urine or pseudoaneurysm.Conclusions Transmesocolic approach has advantages of reducing trauma and accelerating recovery,which makes it an alternative approach for transperitoneal left LPN,especially with tumors in the ventral side.