腹腔镜肾肿瘤精准剜除术治疗肾门部肿瘤的初步体会

Preliminary experience of laparoscopic precise enucleation for renal hilar tumors

目的探讨应用腹腔镜肾肿瘤精准剜除术治疗肾门部肿瘤的安全性及可行性。方法回顾性分析2019年8月至2021年8月收治的11例肾门肿瘤患者的资料,其中男6例、女5例,平均年龄68.8岁(65~78岁),平均体重指数22.83 kg/m^(2)(19.6~25.1 kg/m^(2)),肿瘤位于左侧6例、右侧5例,肿瘤平均直径3.04 cm(1.8~4.1 cm),R.E.N.A.L.评分平均8.5分(8~9分),术前患肾GFR平均43.7 ml/min(40.2~46.9 ml/min)。11例患者均施行腹腔镜肾肿瘤精准剜除术,术中充分暴露肾门,仔细解剖血管及集合系统,阻断肾动脉后,沿肿瘤包膜,将分支血管和集合系统剥离肿瘤表面,将肿瘤精准从肾门处完整剥离,再分层缝合,止血纱填塞创面。结果所有患者手术均成功,无一例中转肾切除术或开放手术。手术时间平均153.5 min(120~180 min),热缺血时间平均27.8 min(25~35 min),术中出血量平均81.5 ml(50~150 ml),术后无一例患者出现血尿、漏尿、肾周血肿等并发症。术后病理提示10例为透明细胞癌、1例为血管平滑肌脂肪瘤,所有病理标本切缘均为阴性。术后随访6个月,均无复发或转移,患肾GFR平均28.2 ml/min(22.4~34.1 ml/min)。结论腹腔镜下精准剜除术治疗肾门部肿瘤是安全可行的。

Objective To investigate the safety and feasibility of laparoscopic precise enucleation in the treatment of renal hilar tumors.Methods We retrospectively analyzed the data of 11 patients with renal hilar tumors admitted from August 2019 to August 2021,including 6 males and 5 females.Their average age was 68.8 years(65-78 years),and their average body mass index is 22.83 kg/m 2(19.6-25.1 kg/m ^(2)).Six cases of tumors were located in the left kidney,and 5 cases were located in the right kidney.The average tumor diameter was 3.04 cm(1.8-4.1 cm),the average R.E.N.A.L.score was 8.5 points(8-9 points),and the average preoperative GFR was 43.7 ml/min(40.2-46.9 ml/min).All 11 patients were treated with laparoscopic precise enucleation of renal tumors.The kidney hilum was fully exposed during the operation,and the blood vessel and collection system were carefully dissected.After the renal artery was blocked,along the tumor capsule,the branch blood vessels and the collection system were peeled off the surface of the tumor,and the tumor was completely peeled from the kidney hilum accurately.Then the incision was sutured layer by layer,and hemostatic gauze was used to fill the wound.Results All patients were successfully operated,and no patients were transfered to nephrectomy or open operation.The duration of surgery was 153.5 min(120-180 min),the mean warm ischemia time was 27.8 min(25-35 min),and the mean blood loss during the operation was 81.5 ml(50-150 ml).No patient had complications such as hematuria,leakage of urine or perirenal hematoma after the operation.The postoperative pathology report indicated 10 clear cell carcinomas and 1 angiomyolipoma.All margins were negative.The patients were followed up for 6 months after the operation,and there was no relapse or metastasis.The average renal GFR was 28.2 ml/min(22.4-34.1 ml/min).Conclusions Laparoscopic precise enucleation in treatment of renal hilar tumors is a safe and feasible solution.