腹腔镜下肾脏部分切除术(附58 例报告)

Laparoscopic Partial Nephrectomy: AReport of 58 Cases

  • 摘要: 目的:探讨腹腔镜下肾脏部分切除术的临床疗效。方法:肾肿瘤患者58例,包括肾癌43例,血管平滑肌脂肪瘤14例,肾素瘤1 例。瘤体直径1~6cm,平均2.5 ± 1.5cm,均采用后腹腔镜下肾肿瘤剜除术。手术过程:分离暴露肾动脉和瘤体,血管阻断夹阻断肾动脉,距离瘤体1cm用超声刀剜除完整瘤体,1-0 可吸收线间断缝合创面,解除血管阻断,观察出血情况,对出血点予以缝合止血,取出肿瘤,完成手术。结果:3 例因瘤体较大,或多支动脉仅夹闭1 支而出血较多中转开放。手术时间65~200min,平均95± 43min;术中出血20~1 500mL,平均140 ± 60mL。血管阻断时间最初10例30~45min,后48例仅为8~28min;肠道功能12~36h恢复,绝对卧床3~5d 后下床活动,术后住院7~10d。随访6~48个月。术后肾图显示患侧肾脏血流良好,功能无明显异常;1 例切口种植转移,1 例肾门淋巴结转移,2 例因术后病理报告切缘阳性而再次开放手术行根治性切除。结论:后腹腔镜下保留肾单位的肾肿瘤切除术除具有创伤小,康复快等优点外,还可以有效保留肾脏功能,适合于处理外生性生长、直径<4cm的恶性肿瘤或者稍大良性肿瘤。手术对术者腔镜下缝合打结技巧要求较高,血管控制时间一般不超过30min,需要有一定经验的医师操作。

     

    Abstract: Objective:To investigate the clinical value of laparoscopic partial nephrotomy.Methods:Fifty-eight patients were treated with laparoscopic surgeries, of which43had renal tumors, 14had hamartoma and1 had Renin tumor. The di -ameter of tumors ranged1-6 cm, (2.5 ± 1.5cm on average). Surgeries were performed through retroperitoneal route: expos -ing the tumor and renal artery; dragging the renal artery with block folder; resecting the tumor with 1cm normal renal tissue by Ultracision; compressing the wound surface with homeostasis carcasses and suturing it with line; relaxing the tube;tak-ing out the tumor tissue and finishing the surgery. Results: Three cases were turned to open surgery because of tumor of large size or multi-artery or bleeding. The surgical duration ranged from 65to 200 min, with an average of 95± 43min. The introperative blood loss was 20to 1500mL approximately, with an average of 140 ± 60mL. The artery block time was 30-45 min in the first10cases and 8-28min in the other cases. Intestinal tract function recovery time and the postoperative hospi-tal stay were 12-36hours and 10-14days, respectively. The patients must stay in bed for 7 to 10days. During follow up of 6 to 48months, patients' renal blood flow showed no obvious abnormal features,1 case had incision metastasis, 1 case had renal portal lymph node metastasis, 2 cases had pathological positive margin and were treated with open radical resec -tion. Conclusion:The laparoscopic enucleation of the renal tumors is a non-invasive, safe and effective therapy and can be considered as the first choice for patients with exophytic malignant tumors smaller than 4cm and benign tumors of larger size.

     

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