维持性血液透析患者后腹腔镜肾癌根治术的安全性

目的探讨后腹腔镜根治性肾切除术治疗维持性血液透析合并肾癌患者的安全性。方法回顾性分析我院2013年1月~2019年3月9例终末期肾病(维持性血液透析)合并肾癌患者的临床资料。肿瘤最大径平均3.7 cm(1.2~5.4 cm),临床分期T 1N 0M 0。维持性血液透析时间19~62个月,平均50个月。均行后腹腔镜根治性肾切除术。术前改善全身一般状况并加强血液透析,围手术期予普通血液透析和无肝素血液透析相结合的方法行肾脏替代治疗,术中、术后限制性补液。结果9例手术均顺利完成,无中转开放、术中输血及死亡。手术时间67~160 min,平均102.9 min。术中出血量40~120 ml,平均73.3 ml。术后第1天即行无肝素血液透析,恢复普通血液透析时间6~7 d。术后急性左心衰竭1例,皮下气肿1例,均对症治愈。术后住院时间7~12 d,平均8.1 d。术后随访5~70个月,平均35个月,均存活,未见肿瘤复发及远处转移,继续血液透析。结论只要术前准备充分,围手术期周密管理,加之个体化补液和及时血液透析,维持性血液透析患者并发肾癌行后腹腔镜手术安全有效。

On Safety of Retroperitoneoscopy in Maintenance Hemodialysis Patients With Renal Cell Carcinoma

Objective To explore the safety of retroperitoneal laparoscopic radical nephrectomy(RLRN)for renal cell carcinoma(RCC)in maintenance hemodialysis patients.Methods The clinical data of 9 patients with end-stage renal diseases(ESRD)who underwent maintenance hemodialysis complicated with non-metastatic RCC diagnosed in our hospital from January 2013 to March 2019 were retrospectively analyzed.The mean largest dimension of the tumor was 3.7 cm,ranging from 1.2 to 5.4 cm.The clinical stage of the tumors was T 1N 0M 0.The mean duration of dialysis before diagnosis of RCC was 50 months,ranging from 19 to 62 months.All the patients underwent the RLRN.The general condition of patients was improved and hemodialysis was strengthened before operation.The perioperative renal replacement treatment was regular hemodialysis combined with non-heparin hemodialysis.Fluid infusion was restricted during and after operation.Results All the operations were completed successfully without conversion to open surgery.No mortality was found.There was no blood transfusion during the period of operation.The operation time ranged from 67 to 160 min(mean,102.9 min).The amount of bleeding ranged from 40 to 120 ml(mean,73.3 ml).All the patients were treated with non-heparin hemodialysis on the postoperative day 1.Regular hemodialysis was restarted on the postoperative day 6 or 7.Postoperative complications were observed in two cases,comprising of one case of acute left heart failure and one case of subcutaneous emphysema.All the patients recovered successfully and were discharged after operation in 7-12 d(mean,8.1 d).The follow-up duration ranged from 5 to 70 months(mean,35 months).All the patients survived and were still under hemodialysis.No recurrence or metastasis was found.Conclusion As long as full preoperative preparation,meticulous perioperative management,individualized fluid infusion and timely hemodialysis,RLRN can be performed in maintenance hemodialysis patients with RCC safely and effectively.