后腹腔镜下肾部分切除术在治疗肾脏肿瘤中的临床疗效

目的 探讨后腹腔镜下保留肾单位的肾部分切除术在治疗肾脏肿瘤的临床应用价值.方法 回顾性分析施行后腹腔镜保留肾单位的肾部分切除术的70例患者的临床资料,其中男42例,女28例,年龄平均(56±11.8)岁,肿瘤直径(3.4士1.3)cm.结果 70例患者均成功在后腹腔镜下实施手术,无1例术中中转为开放手术.手术时间100～180 min,平均(130±27)min.血管阻断时间20～40min,平均每例患者25 min.术中失血50～800mL.术后出血2例:1例发生在术后第4天,行选择性血管栓塞术后好转；另1例出现在术后第7天,经选择性血管栓塞后未见好转遂行患肾切除术.术后病检:肾透明细胞癌53例,肾乳头状癌12例,肾嫌色细胞癌2例,囊性肾癌2例,肾脏囊肿并出血1例.随访3～18个月无局部复发及远处转移.结论 后腹腔镜下保留肾单位的肾部分切除术治疗早期肾脏肿瘤安全、有效,兼有创伤小、康复快等优点,近期疗效满意,远期疗效有待进一步观察.

Clinical value of laparoscopic partial nephrectomy in the treatment of renal carcinoma

ObjectiveTo investigate the clinical value of nephron sparing laparoscopic partial nephrectomy in the treatment of renal carcinoma. Methods Clinical data of 70 patients, including 42 males and 28 females, undergoing retroperitoneal nephron sparing laparoscopic partial nephrectomy, were retrospectively analyzed. The average age of patients was 56 years, and the average size of tumors was 3.4 cm. ResultsAll 70 operations were conducted successfully with laparoscopic surgery. The operation time was 100~180 min （mean 130 min）, renal artery blood flow occlusion time was 20~40 min （mean 25 min） and blood loss was 50~800 mL. Two patients developed complication of bleeding. One case was improved after selective vascular embolization, and the other recovered after open radical nephrectomy. The postoperative pathological results showed 53 cases were renal clear cell carcinoma, 12 cases were renal papillary carcinoma, 2 cases were chromophobe renal cell carcinoma, 2 cases were cystic renal cell carcinoma, and 1 case was renal cysts with bleeding. During the follow up of 3~18 months, no tumor recurrence or metastasis was found. ConclusionNephron sparing laparoscopic partial nephrectomy is safe and effective in the treatment of early stage renal carcinoma. It reduces damage and shortens recovery time. However, its long term effect needs further observation.