单孔腹腔镜肾癌保肾手术68例经验总结

Laparoendoscopic single-site nephron sparing surgery for renal cell carcinoma: clinical experience with 68 cases

目的:总结单孔腹腔镜肾癌保肾手术临床应用经验,分析其适应证、安全性、手术方式的选择及治疗效果。方法:回顾性分析2010年12月—2021年6月笔者分别在上海长海医院(22例)、上海第九人民医院(46例)主刀完成的单孔腹腔镜肾部分切除术(13例)、单孔腹腔镜肾癌冷冻消融术(33例)和单孔腹腔镜免缝合肾部分切除术(22例),评估单孔腹腔镜的手术效果、手术并发症及近、远期治疗效果。结果:所有手术均顺利完成,未增加额外切口。肿瘤平均最大径2.6(1.5~6.2)cm,术后平均住院3.3(3~5)d。术后1例因并发出血行DSA栓塞术止血,其余病例均未出现明显术中及术后并发症。结论:经典单孔腹腔镜下肾部分切除术对外生性肿瘤可行并有一定优势。免阻断的单孔腹腔镜肾肿瘤冷冻消融术风险小、恢复快、肾功能影响小,为一般情况差、合并症多、孤立肾肿瘤、双肾肿瘤及畏惧切除性手术等部分肾肿瘤人群提供了理想选择。外生型T_(1a)期肾癌行肾部分切除术的患者,可尝试单孔腹腔镜下免缝合技术,该术式能够更精准地保留肾单位,并缩短术者单孔腹腔镜的学习曲线。

Objective:To summarize the clinical experience of laparoendoscopic single-site(LESS)partial nephrectomy,and analyze its indications,safety,surgical options,and therapeutic outcomes.Methods:We analyzed LESS partial nephrectomy(13cases),LESS cryoablation of renal cancer(33cases),and LESS sutureless partial nephrectomy(22cases)performed by the author from December 2010to June 2021,and evaluated surgical effects,complications,and short-and long-term outcomes.Among these cases,22were done at Shanghai Changhai Hospital and the other 46cases were performed at Shanghai Ninth People's Hospital.Results:All procedures were performed successfully and no additional incisions were added.The tumors'mean diameter was 2.6(1.5-6.2)cm and the mean length of hospital stay was 3.3(3-5)days after surgery.Postoperatively,one case underwent embolization with DSA because of blood loss,and the remaining cases showed no obvious intraoperative or postoperative complications.Conclusion:Classical LESS partial nephrectomy is feasible for exophytic kidney tumors.LESS cryoablation of renal cancer is associated with low risk,rapid recovery,and little impact on renal function,thus providing an ideal option for some renal tumor populations,such as those with poor general condition,many comorbidities,solitary renal tumors,double renal tumors,or fear of resective surgery.In patients with T_(1a) stage exophytic renal tumor,the LESS sutureless partial nephrectomy can be tried,which more precisely preserves the nephron and shortens the learning curve of LESS.