Crossed renal ectopia with rectal cancer:A case report

BACKGROUND Crossed renal ectopia(CRE)occurs when one kidney crosses the midline from the primary side to the contralateral side while the ureter remains on the primary side.Rectal cancer,one of the most common malignant tumors of the digestive tract,refers to cancer from the dentate line to the rectosigmoid junction.The concurrent presentation of CRE alongside rectal cancer is an uncommon clinical observation.CASE SUMMARY Herein,we report a 69-year-old male patient with rectal cancer who was diagnosed with CRE via computed tomography during hospitalization.Following thorough preoperative evaluations,the patient underwent Dixon surgery.CONCLUSION We performed laparoscopic radical resection of rectal cancer and adequate lymph node removal in a patient with CRE with no postoperative discomfort.

Nephron-sparing surgery for small renal cell carcinoma

Objective：To investigate the method and effect of nephron-sparing surgery in the treatment of small renal cell carcinoma. Methods： From August 1 997 to October 2008, 48 cases of small renal cell carcinomas were confirmed by surgery and pathology, and reviewed retrospectively. Of the 48 cases, there was 1 patient with bilateral tumors, 8 with solitary kidney tumors, 1 with unilateral tumor and a damaged contralateral kidney, and 38 with unilateral tumors and a normal contralateral kidney; 9 underwent tumor enucleation and the remaining patients received partial nephrectomy. Results：There were no local tumor recurrences and/or tumor metastasis at a mean followup of 60 months. Conclusion： Confirming conclusions from other centers, we have found that nephron-sparing surgery is an effective treatment for small renal cell carcinomas.

CTA对于后腹腔镜下肾部分切除术的指导意义

目的探讨计算机体层摄影血管造影(CTA)对肾动脉、肾静脉变异的评估价值及其对后腹腔镜下肾部分切除术的指导意义。方法回顾性分析2015年9月至2022年6月于本院行后腹腔镜下肾部分切除术患者的临床资料,根据是否行CTA检查将其分为对照组(47例,术前行常规检查)和观察组(77例,术前行常规检查+CTA)。比较两组的手术效果。结果观察组的手术时间、肾动脉阻断时间短于对照组,术中出血量少于对照组(P<0.05)。124例患者中,50例患者存在肾动脉变异,其中36例通过术前CTA发现,2例是观察组在手术过程中发现,其余12例均为对照组在手术过程中发现;CTA诊断肾动脉变异的准确率为94.74%。19例患者存在肾静脉变异,均通过术前CTA发现且在术中得到确认;CTA诊断肾静脉变异的准确率为100.00%。两组患者的术后并发症总发生率、术后引流时间、术后住院时间无显著差异(P>0.05);术后,两组患者的尿素氮、血肌酐水平均低于术前,且观察组低于对照组(P<0.05)。结论CTA可清楚地观察到肾变异血管的分支走行,弥补普通CT图像对于血管成像方面的不足,为手术方案选择节省时间,并减少术中大出血的可能。但在少部分患者中,CTA不能体现真实的肾动脉情况,所以需要通过完善术前检查以及制定个体化手术方案来减少术中意外的发生。

Small renal masses in kidney transplantation:Overview of clinical impact and management in donors and recipients

Kidney transplantation is the best replacement treatment for the end-stage renal disease.Currently,the imbalance between the number of patients on a transplant list and the number of organs available constitutes the crucial limitation of this approach.To expand the pool of organs amenable for transplantation,kidneys coming from older patients have been employed;however,the combination of these organs in conjunction with the chronic use of immunosuppressive therapy increases the risk of incidence of graft small renal tumors.This narrative review aims to provide the state of the art on the clinical impact and management of incidentally diagnosed small renal tumors in either donors or recipients.According to the most updated evidence,the use of grafts with a small renal mass,after bench table tumor excision,may be considered a safe option for high-risk patients in hemodialysis.On the other hand,an early small renal mass finding on periodic ultrasound-evaluation in the graft should allow to perform a conservative treatment in order to preserve renal function.Finally,in case of a renal tumor in native kidney,a radical nephrectomy is usually recommended.

腹腔镜下保留肾单位手术与后腹腔镜肾癌根治术对非晚期肾癌患者免疫功能的影响

目的对比腹腔镜下保留肾单位手术(LNSS)与后腹腔镜肾癌根治术(RLRN)治疗非晚期肾癌患者的效果及对免疫功能的影响。方法回顾性收集商丘市第三人民医院2020-04—2023-04收治的150例非晚期肾癌患者的病例资料,按手术方案不同分为2组。行LNSS治疗的75例患者列为A组,行RLRN治疗的75例患者列为B组。对比2组手术指标,手术前后血尿素氮(BUN)、血肌酐(Scr)、明胶酶相关脂质运载蛋白(NGAL)肾功能,欧洲癌症研究与治疗组织生命质量测定量表(EORTC QOL-C30)评分,免疫功能(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))水平,并发症发生率。结果A组术中失血量少于B组,术后第3天时的BUN、Scr、NGAL水平低于B组,CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平高于B组,术后禁食时间及住院时间短于B组,差异均有统计学意义(P<0.05);A组术后3个月时的EORTC QOL-C30评分高于B组,并发症发生率低于B组,差异有统计学意义(P<0.05)。结论与RLRN治疗非晚期肾癌患者比较,经LNSS治疗有助于减少术中出血量,降低并发症发生风险,缩短患者康复进程,提升生活质量,且对机体肾功能、免疫功能造成的影响较小。

原发性肝癌患者腹腔镜根治术后急性肾损伤发生的高危影响因素

目的探讨原发性肝癌(PLC)患者腹腔镜根治术后急性肾损伤(AKI)发生的影响因素,为临床防治AKI提供参考。方法选取100例PLC患者作为研究对象,依据腹腔镜根治术后是否发生AKI分为发生组与未发生组,收集2组基础资料,先行单因素分析,待获得有差异的项目后再行Logistic回归分析,获得影响PLC患者腹腔镜根治术后发生AKI的独立危险因素。结果100例PLC患者腹腔镜根治术后有14例发生AKI,发生率为14.00%(14/100)。2组手术时间、术中出血量、糖尿病、血清白蛋白水平、肌酐水平、尿酸水平及血红蛋白相比,差异有统计学意义(P<0.05);多因素显示,手术时间≥2 h、术中出血量≥500 ml、糖尿病、血清白蛋白水平<35 g/L、肌酐水平≥70μmol/L、尿酸水平≥360μmol/L、血红蛋白<100 g/L为影响PLC患者腹腔镜根治术后发生AKI的高危因素(P<0.05且OR>1)。结论手术时间≥2 h、术中出血量≥500 ml、糖尿病、血清白蛋白水平<35 g/L、肌酐水平≥70μmol/L、尿酸水平≥360μmol/L、血红蛋白<100 g/L是影响PLC患者腹腔镜根治术后发生AKI的高危因素,临床还需及早识别上述因素,并开展针对性干预,以降低AKI发生风险,改善患者预后。

Treatment options for localised renal cell carcinoma of the transplanted kidney

Currently,there is no consensus among the transplant community about the treatment of renal cell carcinoma(RCC)of the transplanted kidney.Until recently,graftectomy was universally considered the golden standard,regardless of the characteristics of the neoplasm.Due to the encouraging results observed in native kidneys,conservative options such as nephron-sparing surgery(NSS)(enucleation and partial nephrectomy)and ablative therapy(radiofrequency ablation,cryoablation,microwave ablation,high-intensity focused ultrasound,and irreversible electroporation)have been progressively used in carefully selected recipients with early-stage allograft RCC.Available reports show excellent patient survival,optimal oncological outcome,and preserved renal function with acceptable complication rates.Nevertheless,the rarity and the heterogeneity of the disease,the number of options available,and the lack of long-term follow-up data do not allow to adequately define treatment-specific advantages and limitations.The role of active surveillance and immunosuppression management remain also debated.In order to offer a better insight into this difficult topic and to help clinicians choose the best therapy for their patients,we performed and extensive review of the literature.We focused on epidemiology,clinical presentation,diagnostic work up,staging strategies,tumour characteristics,treatment modalities,and follow-up protocols.Our research confirms that both NSS and focal ablation represent a valuable alternative to graftectomy for kidney transplant recipients with American Joint Committee on Cancer stage T1aN0M0 RCC.Data on T1bN0M0 lesions are scarce but suggest extra caution.Properly designed multi-centre prospective clinical trials are warranted.

Assessment of Warm and Cold Ischemia on Functions of the Operated Kidney with ^99mTc-DMSA in Renal Masses: A Prospective and Randomized Study

Objective: To examine the effect of warm and cold ischemia on functions of the operated kidney in cases with a normal contralateral kidney undergoing nephron sparing surgery. Methods: This study enrolled 40 patients with a normal contralateral kidney and without a renal function threatening risk factor, who were operated with NSS. The patients were randomized at admission. They were divided into 2 equal groups as warm and cold ischemia. An ice application for 10 minutes was done to cold ischemia group after clamping renal artery. Renal functions were evaluated with Technesium-99m-Dimercaptosuccinic Acid (DMSA) and serum creatinine at the preoperative and postoperative (day 1, day 15, month 6, and month 12) period. Statistical analysis was done with Mann Whitney U test, Wilcoxon Signed Rank test, and Fredman test. A p value below 0.05 was considered statistically significant. Results: There were no significant differences between the groups in terms of age, body mass index, ischemia time, tumor size, amount of hemorrhage, and procedure time. Both groups had a significantly higher DMSA uptake at the preoperative period compared with the postoperative period (postoperative day 1, day 15, month 6, and month 12) (p 0.001). However, both groups had similar DMSA uptake results at the postoperative period. Preoperative and postoperative creatinine levels were not significantly different from each other in both groups. Conclusion: Based on tumor localization, nephron sparing surgery without use of superficial cooling appears as a viable option for small renal masses.

探讨基于联合解剖标志、层面及腹膜返折悬吊术的程序化六步法后腹腔镜下肾癌根治术治疗局限性肾癌的临床效果

目的探讨基于联合解剖标志、层面及腹膜返折悬吊术的程序化六步法后腹腔镜下肾癌根治术治疗局限性肾癌的临床应用价值。方法40例局限性肾癌患者作为研究对象,按照随机数字表法将患者分为对照组和试验组,每组20例。对照组采用传统开放肾癌根治术治疗,试验组采用基于联合解剖标志、层面及腹膜返折悬吊术的程序化六步法后腹腔镜下肾癌根治术治疗。比较两组患者的临床观察指标、输血率、并发症发生率,观察两组患者的术后随访结果。结果试验组患者的术中出血量(45.50±21.87)ml少于对照组的(89.00±38.09)ml,手术时间(109.95±19.17)min、术后下床活动时间(19.65±4.91)h、术后肠道功能恢复时间(23.35±6.69)h、术后引流管拔除时间(2.45±0.51)d、术后住院时间(5.45±0.99)d均短于对照组的(132.45±19.34)min、(33.85±6.99)h、(40.60±8.31)h、(5.05±1.05)d、(7.15±1.46)d,术后视觉模拟评分法(VAS)评分(4.10±1.33)分低于对照组的(7.80±1.36)分,差异有统计学意义(P<0.05)。两组患者的输血率、术后并发症发生率比较,差异无统计学意义(P>0.05);试验组患者的术中并发症发生率5%低于对照组的40%,差异有统计学意义(P<0.05)。术后随访9个月,无失访患者。两组患者均未发现有局部复发和远处转移者。结论采用基于联合解剖标志、层面及腹膜返折悬吊术的程序化六步法后腹腔镜下肾癌根治术作为局限性肾癌的手术治疗方法是安全有效的,术中严格执行程序化手术操作,循序渐进,手术有条不紊,术中能建立良好的手术操作暴露视野、外科层面解剖清晰,早期快速定位及阻断肾蒂血管及分支、变异血管,减少术中并发症的发生,缩短手术时间,患者术后恢复快、疼痛轻,未出现局部复发及远处转移的病例,能让患者受益,值得临床推广。

全程优质护理模式结合心理疏导模式在肾癌手术患者中的应用

目的:探讨全程优质护理模式结合心理疏导模式在肾癌手术患者中的应用效果。方法:选取2019年1月1日~2020年12月31日接受肾癌手术治疗的80例患者随机分为对照组和观察组各40例,对照组采用常规护理模式,观察组采用全程优质护理模式结合心理疏导模式。比较两组干预效果。结果:观察组术前焦虑、抑郁水平低于对照组(P<0.01),术后并发症发生率低于对照组(P<0.01),住院时间和住院费用少于对照组(P<0.01),患者满意度高于对照组(P<0.01)。结论:全程优质护理模式结合心理疏导模式能有效降低肾癌手术患者的术前焦虑、抑郁水平及术后并发症发生率,缩短住院时间,提高患者护理满意度,值得临床推广应用。

ArtiSentialTM Revolutionizes Traditional Laparoscopy in Urology by Introducing the Dexterity of a Robotic System to a Laparoscopic Instrument —First Experiences in Urology in Europe by the Ukrb in Neuruppin

We describe the first two conventional, laparoscopic renal operations with a new multi-degree of freedom articulated single-use laparoscopic instrument (ArtiSentialTM). The two patients underwent different laparoscopic interventions at Ukrb University (Neuruppin, Germany): nephrectomy and Anderson-Hynes-pyeloplasty. All procedures were completed, with no need for conversion or placement of additional ports. No intraoperative complications or technical failure of the instrument was recorded. The mean operative time was 180 min median length of stay was 11.5 d. The instrument could be opened out of the sterile packaging and used at once when it was needed, because it is a single-use instrument. There was real haptical feedback and the costs are minimal compared to robot surgery. The use was straightforward and rapid processes after an intensive training of 4 h in a dry lap. Awaiting future investigations in larger series, this study proves the safety and feasibility of renal surgery with ArtiSentialTM and provides relevant data that may help early adopters of this surgical instrument.

乌司他丁、帕瑞昔布钠联合胸腹腔镜根治术对食管癌患者炎症指标的影响

目的 探讨针对食道癌患者采取胸腹腔根治术联合乌司他丁、帕瑞昔布钠治疗对其炎症指标的影响。方法 采用随机数表法将2017年7月—2019年6月山东省菏泽市立医院收治的食管癌患者73例分为对照组36例,观察组37例。对照组实施胸腹腔镜根治术联合乌司他丁治疗,观察组在对照组基础上加用帕瑞昔布钠治疗。对比分析两组治疗前后血清炎症水平及肝肾功能指标。结果 观察组治疗后的肿瘤坏死因子(tumor necrosis factor-α,TNF-α)、白介素细胞-6(interleukin-6,IL-6)、白介素细胞-8(interleukin-8,IL-8)天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、血肌酐(serum creatinine,Scr)、尿素氮(urea nitrogen,BUN)分别为(9.13±2.34)ng/L、(19.06±8.61)ng/L、(198.71±43.12)ng/L、(41.01±13.21)U/L、(61.24±8.85)μmol/L、(8.11±1.86)mmol/L,对照组治疗后的TNF-α、IL-6、IL-8、AST、Scr、BUN分别为(13.71±3.10)ng/L、(23.72±10.16)ng/L、(241.43±42.72)ng/L、(49.67±15.43)U/L、(70.43±10.06)μmol/L、(12.03±2.03)mmol/L,治疗后,两组均有改善,但观察组患者TNF-α、IL-6、IL-8、AST、Scr、BUN指标水平低于对照组,差异有统计学意义(P<0.05)。结论 针对食管癌患者采取胸腹腔镜根治术联合乌司他丁、帕瑞昔布钠治疗,能够有效降低患者炎症反应,减轻肝肾功能损伤。

后腹膜机器人与腹腔镜肾肿瘤部分切除术:一项单一外科医生围手术期疗效的配对比较

目的:应用R.E.N.A.L.肾功能评分系统进行配对分析,比较腹膜后腹腔镜肾部分切除术(Laparoscopic Partial Nephrectomy,LPN)与机器人肾部分切除术(Robot-assisted Partial Nephrectomy,RPN)的围手术期疗效。方法:对2016年1月—2020年3月543例于浙江大学医学院附属第一医院泌尿外科行腹腔镜及机器人辅助肾部分切除术患者的相关临床资料进行分析。根据R.E.N.A.L.肾功能评分、性别和年龄进行1∶1配对(112对配对),通过统计分析对围手术期结果进行比较。结果:LPN组和RPN组在年龄、性别、体重指数(Body Mass Index,BMI)、肿瘤大小、美国麻醉学家协会(American Society of Anesthesiologists,ASA)评分和术前估算肾小球滤过率(Estimated Glomerular Filtration Rate,eGFR)方面均无显著差异。接受LPN的患者左侧肿瘤所占比例略高(51.7%Vs42.9%,P=0.032)。两组在手术时间、术中出血量、术后住院时间(Length of Stay,LOS)、术后eGFR、输血量和/或术后并发症等方面均无显著差异。RPN组热缺血时间(Warm Ischemia Time,WIT)明显比LPN组短(18.9 min Vs22.6 min,P=0.032)。以复杂性为特点的亚集分析显示,复杂肿瘤RPN的WIT显著短于LPN(21.1 min Vs 26.3 min,P=0.012),而单纯性肿瘤RPN与LPN的WIT差异无统计学意义(16.4 min Vs 18.3 min,P=0.085)。结论:经腹膜后RPN手术时间较经腹膜后LPN短,但二者围手术期效果基本相同。在有限的腹膜后工作空间内进行复杂的肿瘤切除和修补,机器人辅助手术可能比传统的腹腔镜术更具优势。

小儿麻痹后遗症患者机器人辅助肾肿瘤根治术的体位探讨

目的:探讨小儿麻痹后遗症患者机器人辅助下肾肿瘤根治术的安全体位。方法:回顾性分析2021年4月—2022年6月中山大学附属第一医院泌尿外科收治的3例接受机器人肾恶性肿瘤根治术的小儿麻痹后遗症患者临床资料、术中体位情况和临床资料。结果:3例患者均成功实施机器人辅助下肾盂癌或肾癌根治手术,无中转开腹。术中采用了截石位、改良截石位和左侧斜仰60°体位,患者术中体位转换顺利进行,未出现机器人操作钳相互碰撞和挤压等情况,未出现需要临时改变机器人Trocar位置或增加Trocar的情况。手术顺利完成,术后无压疮,肢体神经功能完好,无肢体感觉异常或运动功能异常。结论:采用改良的体位进行小儿麻痹后遗症患者机器人辅助下肾恶性肿瘤根治术是安全可行的。

加速康复外科在腹腔镜肾癌根治术中临床疗效的Meta分析

目的:系统评价加速康复外科理念在腹腔镜肾癌根治术围手术期中的应用价值。方法:搜索PubMed、Cochrane library、Embase、CBM、CNKI、万方数据库、维普数据库中,截至2022年5月比较加速康复外科理念(Enhanced recovery after surgery,ERAS)和传统康复外科管理模式应用于腹腔镜肾癌根治术的临床研究。由2位独立审查者进行文献筛选、资料数据收集及文献质量评价,运用RevMan 5.4版本进行数据分析。结果:共纳入14篇相关文献,9篇为随机对照研究,5篇为回顾性队列研究,共1339例患者。ERAS组636例,传统康复外科组703例。Meta分析结果示,在围手术期应用ERAS的患者术后首次排气时间[SMD=-2.54,95%CI(-3.34,-1.75),P<0.00001]、首次进食时间[SMD=-2.97,95%CI(-3.42,-1.91),P<0.00001]、首次下床活动时间[SMD=-3.00,95%CI(-3.62,-2.38),P<0.00001]、术后拔除导尿管[SMD=-3.17,95%CI(-4.62,-1.71),P<0.00001]及拔除引流管时间[SMD=-2.36,95%CI(-3.15,-1.56),P<0.00001]更早,术后住院时间更短[MD=-2.76,95%CI(-3.63,-1.88),P<0.00001],术后并发症总发生率更低[MD=0.51,95%CI(0.38,0.68),P<0.00001],住院费用更少[MD=-0.53,95%CI(-0.64,-0.43),P<0.00001],但两组手术时间[MD=-1.16,95%CI(-2.77,0.45),P=0.16]及术中出血量[MD=-0.99,95%CI(-2.51,0.54),P=0.21]比较,差异无统计学意义。结论:ERAS应用于腹腔镜肾癌根治术可明显加快患者术后恢复,同时减少患者术后住院时间、住院费用、并降低了患者术后并发症的发生率,由于可用的研究数量少及其潜在的异质性,上述结论仍需更多的高质量研究进行验证。

机器人辅助腹腔镜下下腔静脉瘤栓脱落的处理(“大家泌尿网”观看手术视频)

肾癌合并下腔静脉瘤栓一直是泌尿外科手术治疗中的难点,该手术解剖关系复杂,涉及肾脏、肝脏及心脏等重要器官的血管阻断以及下腔静脉的阻断和重建,术中可能出现瘤栓脱落导致急性肺栓塞,手术难度极大,风险极高。本文报告了1例对机器人辅助腹腔镜手术治疗右肾肿瘤合并下腔静脉瘤栓手术过程中瘤栓脱落的成功处理,结合目前肾癌合并下腔静脉瘤栓脱落处理的现状,探讨机器人辅助腹腔镜下下腔静脉瘤栓脱落的处理方法,旨在帮助临床医生制定严密的手术应对策略,避免发生因瘤栓脱落引起致死性肺栓塞。

机器人辅助腹腔镜治疗侵犯双侧输尿管开口去势抵抗性前列腺癌一例报道

2021年6月徐州医科大学附属医院收治1例75岁去势抵抗性前列腺癌(Castration-resistant Prostate Cancer,CRPC)患者。泌尿系彩超:双肾积水,双侧输尿管全程扩张;前列腺大小约6.1cm×3.4cm×4.7cm,部分向膀胱突入,呈菜花样,范围约5.7cm×2.4cm。残余尿249ml,血肌酐1185μmol/L,初步诊断为前列腺癌侵犯双侧输尿管开口(T4期)。经双肾造瘘、透析治疗后血肌酐降至93μmol/L。因合并尿潴留及肾功能不全,患者及家属手术意愿强烈,经沟通手术风险并签署知情同意书后行“机器人辅助腹腔镜下前列腺癌切除+膀胱下半部切除+双侧输尿管膀胱再植术”。手术过程顺利,用时约320min,术中出血350ml,术后3周拔除尿管。随访至今,患者血肌酐维持正常范围,有轻微尿失禁,国际前列腺症状评分(International Prostate Symptom Score,IPSS)及生活质量(Quality of Life,QoL)评分较术前明显提高。结果表明,机器人辅助腹腔镜治疗侵犯双侧输尿管开口去势抵抗性前列腺癌是安全、有效的,既可以达到减瘤作用,又解决了尿潴留及肾功能衰竭等并发症。相比术前患者排尿症状及生活质量明显提高,值得临床进一步尝试,但需进一步随访及扩大样本量进行比较分析。

后腹腔镜保留肾单位手术治疗70岁以上老年局限性肾癌

目的探讨后腹腔镜保留肾单位手术治疗70岁以上老年局限性肾癌的疗效。方法 2011年9月~2014年12月对16例70岁以上肾癌行后腹腔镜肾部分切除术。建立后腹腔气腹后分别置入3枚trocar,打开侧椎筋膜,在腰大肌与肾脂肪囊间分离,上至膈肌,下至输尿管。游离肾脏中部,找到肾动脉,找到并游离肿物,置入血管阻断钳夹闭肾动脉,剪刀距肿瘤边缘0.5 cm切除肿物及部分肾实质,3-0可吸收线缝合集合系统(肿瘤位置较深邻近集合系统者),以2-0倒刺线连续贯穿缝合肾实质,缝合完毕后以Hem-o-lok夹固定。松开血管阻断钳,出血部分加强缝合。结果 16例手术均成功完成,无中转开放。手术时间55~240 min,(132.4±46.4)min,血管阻断时间12~40 min,(25.3±7.6)min;术中出血量10~200 ml,(79.7±62.6)ml,无输血。术后住院时间6~15 d,(9.4±3.2)d。16例随访(30.8±9.5)月,1例术后24个月因全身肿瘤转移死亡,1例术后31个月因心脏疾病死亡,其余患者无复发、转移。1例术后18个月出现肾功能衰竭,规律行腹膜透析。结论后腹腔镜保留肾单位手术治疗70岁以上老年局限性肾癌安全有效,条件允许时推荐采用。

保留肾单位手术应用及研究进展

越来越多的研究表明,对于T1a期肾癌患者的中长期随访发现,根治性肾切除术与保留肾单位手术的肿瘤学治疗效果无明显差异,但保留肾单位手术能够更好地保留肾功能并可提高病患生存质量。因此,其已逐渐将其作为局限性肾肿瘤的标准术式。对保留肾单位手术的应用及研究也越来越广泛和深入,其适应证也在逐渐扩展。文中主要对保留肾单位手术的应用及研究进展进行综述,探讨保留肾单位手术目前的技术手段及前景展望。

后腹腔镜下保留肾单位与根治性肾切除术治疗T1bN0M0期肾癌的疗效比较

目的比较后腹腔镜下保留肾单位手术(retroperitoneoscopic nephron sparing surgery,RPNSS)与根治性肾切除术(retroperitoneoscopic radical nephrectomy,RPRN)治疗T1b N0M0期肾癌的临床疗效。方法回顾性分析2009年1月-2013年7月在我院行后腹腔镜下保留肾单位手术的T1b N0M0期肾癌16例及根治性肾切除术患者40例。比较两组手术时间、术中出血量、术后输血情况、术后并发症、引流时间、术后肌酐水平、局部复发及远处转移等指标。结果两组手术时间、术中出血量的差异有统计学意义(P<0.05)。在术后输血情况、引流时间、术后肌酐、局部复发及远处转移方面差异均无统计学意义(P>0.05)。结论腹腔镜下保留肾单位手术治疗T1b N0M0期肾癌疗效可靠,术后对患者的肾功能影响较小,与根治性肾切除术的局部复发及转移情况相似。