后腹腔镜肾错构瘤剜除术：附15例报告

目的探讨后腹腔镜保留肾单位手术治疗肾错构瘤的方法和疗效。方法2008年5月至2010年11月,实施后腹腔入路腹腔镜肾错构瘤剜除术15例,本组15例,女12例,男3例,年龄19～57岁,平均39岁。肿瘤均位于肾脏的背侧,左侧11例,右侧4例。肿瘤大小3．5～7cm,平均4．6cm。结果15例手术均取得成功,无中转开放。手术时间70～160min,平均110min。出血量40-150ml,平均70ml。术后住院时间4～8d,平均5d。无输血,无尿漏和继发性出血等并发症。14例术后随访2～25个月,1例失访。无肿瘤复发,患肾功能正常。结论后腹腔镜下肾错构瘤剜除术安全可行,是一种值得推广的治疗方法。     

后腹腔镜肿瘤剜除术治疗肾错构瘤(附20例报告)

目的:探讨后腹腔镜保留肾单位手术治疗肾错构瘤的手术技巧和临床效果。方法:采用后腹腔镜技术对20例肾错构瘤患者行肿瘤剜除术。其中择期手术患者19例,因肾错构瘤破裂出血急诊手术1例。肿瘤直径1.8～8.7cm,平均4.8cm。采用单纯肾动脉阻断并以吸引器吸除肿瘤的手术方法,观察手术时间、术中出血量、术后住院天数和术中术后并发症及手术效果。结果:20例手术均获得成功,无中转开放手术。平均手术时间119min,19例择期手术患者平均出血量85ml,急诊患者未行肾动脉阻断,术中出血约为1 000ml。平均术后住院时间9.9d。1例术后出现尿瘘,经保守治疗愈合出院。其他患者无围手术期并发症。术后随访3～60个月,无肿瘤复发。结论:后腹腔镜肾错构瘤剜除术应用肾动脉热缺血阻断、介入超声、吸引器吸除肿瘤、术前放置输尿管导管、止血手段等新技术安全可行,具有创伤小、并发症少、恢复快、住院时间短等优点。     

后腹腔镜手术治疗肾脏肿瘤5例报告

目的：探讨后腹腔镜肿瘤剜除术和肾部分切除术治疗肾脏肿瘤的应用价值。方法：采用后腹腔镜经后腹腔途径对5例肾肿瘤患者分别行肿瘤剜除术和肾部分切除术，并观察手术时间，术中出血量，术后住院天数和术中术后并发症及手术效果。结果：5例手术全部获得成功，平均手术时间为87min，平均出血量55ml，平均术后住院时间为5．8d，手术效果好，无并发症。结论：该术式肿瘤切除精确彻底，创伤小，出血少，恢复快，有推广应用价值。     

腹腔镜下微波消融剜除术治疗肾脏肿瘤的疗效分析

目的 探讨腹腔镜下微波消融肾肿瘤剜除术治疗肾脏肿瘤的疗效与安全性.方法 本组84例肾肿瘤患者,予以腹腔镜下辅助微波消融,尔后手术剜除肾肿瘤,记录术中出血量、手术时间,观察术中、术后并发症及疗效与安全性.结果 84例患者手术均顺利完成,术中均未阻断肾动脉,无术中大出血或中转开放手术,出血量为50~350 ml,手术时间为70~120 min.术后病理诊断为肾透明细胞癌60例,血管平滑肌脂肪瘤16例,嗜酸性细胞瘤4例,嫌色细胞癌2例,乳头状肾细胞癌2例.术中血管平滑肌脂肪瘤普遍出血较多.术后血管平滑肌脂肪瘤出血1例.全部病例随访12个月,无肿瘤复发、远处转移或死亡病例.结论 腹腔镜下微波消融肾肿瘤剜除术是一种安全有效的保留肾单位的手术方式,具有出血量少、手术时间短、术后并发症少等优点.     

后腹腔镜肾小肿瘤剜除术12例报告

目的探讨后腹腔镜下肾浅在小肿瘤(3cm)剜除术中不阻断肾动脉的可行性。方法 2005年4月～2009年4月对12例肾单发直径1.2～3.0cm的小肿瘤行后腹腔镜肿瘤剜除术。术中游离肾动脉,预置血管夹,以备肾动脉阻断;常规不阻断肾动脉情况下,距离肿瘤边缘1cm以上褥式外翻缝合1～2针,收紧缝线打结,预先缝线阻断肾肿瘤区血供;距离肿瘤边缘0.5～1cm,剜除肾肿瘤。结果 12例后腹腔镜手术均获成功,无中转开放手术。手术时间90～170min,平均130.3min;1例剜除肾肿瘤时出血较明显,需阻断肾动脉,时间约20min。术中出血量80～400ml,平均150.6ml,无大出血输血病例。3例术后出现肉眼血尿,均在术后3d内消失。住院时间5～7d,平均6.7d。术后病理:肾脏透明细胞癌10例,错构瘤2例,切缘均阴性。12例术后随访3个月～3年,平均15.5月,复查肾功能正常,B超、CT检查无肿瘤复发,无肾脏萎缩。结论后腹腔镜肾小肿瘤剜除术中预先缝线阻断肾局部肿瘤区血供,不阻断肾动脉是安全可行的。     

腹腔镜下肾血管平滑肌脂肪瘤单纯剜除术

目的探讨后腹腔镜肾血管平滑肌脂肪瘤单纯剜除术的手术方法及临床疗效。方法2005年6月～2006年12月,采用后腹腔镜途径对11例肾血管平滑肌脂肪瘤行单纯剜除术。术中沿瘤体边缘外用电钩或超声刀切开肾包膜,肿瘤突出部分沿边缘整块取出,深部剩余部分富脂瘤体组织由吸引器吸出,再以小方纱擦拭瘤窝表面,双极电凝止血。生物蛋白胶、止血纱布及可吸收线缝合肾脏创面。结果11例手术均成功完成,无中转开放者。平均手术时间84.5min(60～110min),平均术中出血量51ml(20～100ml),平均术后住院时间8.8d(6～14d),无并发症。术后肾功能正常。随访7～23个月(平均13.4月),影像学检查无局部肿瘤组织残留或复发。结论后腹腔镜肾血管平滑肌脂肪瘤单纯剜除术具有创伤小、出血少、恢复快、住院时间短等优点。     

腹腔镜下行肾血管平滑肌脂肪瘤剜除术治疗10例

目的探讨不阻断。肾蒂腹腔镜下行肿瘤剜除术治疗较小。肾血管平滑肌脂肪瘤（RAML）的应用效果。方法采用腹腔镜经腹腔途径在不阻断肾蒂情况下对10例较小RAML（肿瘤直径〈4cm）行肿瘤剜除术,并观察手术时间、术中出血量、术后住院天数和术中术后并发症及手术效果。结果10例手术全部获得成功,平均手术时间为90min,平均出血量80ml,平均术后住院时间为7d,手术效果好,无并发症,随访3—19个月,未见肿瘤转移或复发。结论该术式肿瘤切除精确彻底,创伤小,出血少,恢复快。     

腹腔镜肾肿瘤剜除术治疗T1b期肾癌32例报告

目的目的评价腹腔镜肾肿瘤剜除术治疗T1b期肾癌的有效性及安全性。方法回顾性分析2007年3月至2012年3月32例临床分期为T1bN0M0期肾癌并行腹腔镜剜除治疗的患者的临床资料,其中男20例、女12例,平均年龄(53.8±5.2)岁,肿瘤平均直径(5.2±1.4)cm,术前检查均未发现远处转移。32例患者中8例行经腹腹腔镜肾癌剜除术,24例行后腹腔镜肾癌剜除术,出院后行CT随访并定期复查血肌酐并计算肾小球滤过率。结果所有患者手术均顺利完成,无中转开放,围手术期无严重并发症。平均手术时间(154.0±22.4)min,术中平均热缺血时间(25.4±5.2)min,术中平均出血量(230.6±18.6)mL,术后平均住院时间(8.1±1.6)d。术后总共6例(18.7%)出现并发症,其中术后短暂血肌酐升高2例,不全性肠梗阻1例(Clavien分级Ⅰ级),术后输血1例(Clavien分级Ⅱ级),术后尿漏2例(Clavien分级Ⅲ级)。无1例患者出现肿瘤切缘阳性,术后平均随访(28.4±8.2)个月,1例患者出现局部复发、复发率3%,余未见复发及转移。术后随访平均eGFR为(69.8±11.9)mL/min,较术前差异无统计学意义(P0.05)。结论腹腔镜肾肿瘤剜除术治疗T1b期肾癌安全、有效,术后对肾功能影响较小,短期随访效果满意。     

后腹腔镜肾部分切除术治疗肾肿瘤疗效观察(附23例报告)

目的:探讨后腹腔镜肾部分切除术(RLPN)治疗肾肿瘤的手术方法及临床效果。方法:2010年3月~2012年12月,对23例肿瘤直径≤4cm的肾肿瘤患者行RLPN,术中采用全层"8"字形间断缝合和免打结分层缝合法修补肾脏创面缺损,观察肾脏热缺血时间、手术时间、术中出血量、术后住院天数、围手术期和近期并发症及手术效果。结果:23例手术均获成功,手术时间70~130min;中位数90min;肾脏热缺血时间15~30min,中位数25min;术中出血量50~260ml,中位数80ml;无术中输血。术后病理示所有肿瘤切缘均阴性。术后住院时间7~13d,中位数8d;术后无出血、尿瘘等并发症发生,围手术期无死亡及二次手术切除肾脏病例。术后平均随访12(3~24)个月,全部无瘤生存,肿瘤未见局部复发及远处转移。结论:RLPN治疗肾肿瘤(肿瘤直径≤4cm)安全、有效,具有较好的临床可行性。     

后腹腔镜肾部分切除术在治疗肾肿瘤的临床应用

目的探讨后腹腔镜保留肾单位的肾部分切除术治疗肾肿瘤的临床应用价值。方法 11例患者施行后腹腔镜保留肾单位的肾部分切除术的临床资料,其中男8例,女3例,年龄平均51.2岁,肿瘤直径3～4cm回顾性分析。结果所有手术均获成功,手术时间70～120min,血管阻断时间20～40min,术中失血100～300ml,术后无出血、尿漏等并发症。术后病理9例肾脏透明细胞癌(T1N0M0),2例肾血管平滑肌脂肪瘤,随访3～15个月无局部复发。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。     

机器人辅助腹腔镜下肾部分切除术两种入路的对比研究

目的:比较经腹膜后和经腹腔两种手术入路机器人辅助腹腔镜下肾部分切除术的临床疗效。方法:回顾性分析2018年6月-2021年1月于甘肃省人民医院行肾部分切除术患者67例的临床资料,根据手术入路不同将患者分为经腹腔组和经腹膜后组。经腹腔入路组患者共26例(男11例,女15例),平均年龄为(53.5±9.7)岁;经腹膜后入路组患者共41例(男20例,女21例),平均年龄为(55.2±12.5)岁。比较两组患者的手术疗效、病理结果和围手术期情况。结果:67例患者的机器人辅助腹腔镜下肾部分切除术均顺利完成,无中转开腹手术。经腹腔入路和经腹膜后入路组术中出血量、热缺血时间、手术时间、术后并发症发生率比较,差异均无统计学意义(P>0.05)。而经腹膜后入路组患者的术后肠道功能较经腹腔入路组恢复快(P<0.05)。结论:采用经腹膜后入路在机器人辅助腹腔镜下肾部分切除术中可以取得和经腹腔入路同样的手术效果,而且其在术后肠道功能恢复方面具有优势。     

Laparoscopic partial nephrectomy for hilar tumors: technique and results

BACKGROUND: Laparoscopic partial nephrectomy for hilar tumors is a cutting edge procedure for which little data is available in the current literature. OBJECTIVE: To describe our technique and results of laparoscopic partial nephrectomy for renal hilar tumors. DESIGN, SETTING, AND PARTICIPANTS: Between April 2000 and September 2006, 94 partial laparoscopic nephrectomies were performed at our institution. A total of 18 (19.1%) patients had hilar tumors. A hilar tumor was defined as a lesion suspicious for renal cell carcinoma in contact with a major renal vessel on preoperative cross-sectional imaging. In 3 (16.7%) of the patients, the indication for nephron-sparing surgery was imperative. Mean tumor size was 3cm (range, 2-4.5). Eight (44.4%) surgeries were performed with renal artery perfusion for cold ischemia; the remaining surgeries were performed under warm ischemia. INTERVENTION(S): After occluding the renal artery and controlling the renal vein by using separate rubber band tourniquets, we excised the tumor mass including delicate mobilization away from the blood vessels. Although we used to insert a ureteral stent at the beginning of our experience with laparoscopic partial nephrectomies, we no longer do so. All surgeries were performed by a single urologist (G.J.). MEASUREMENTS: Operative time, ischemia time, blood loss, renal function using the Cockroft formula as well as renal scans, operative and post-operative complications, pathology parameters. RESULTS AND LIMITATIONS: All surgeries were completed laparoscopically. Mean surgical time was 238min (range, 150-420). Mean ischemia times were 42.5min (range, 27-63) and 34.1min (range, 24-56) for the cold and warm ischemia groups, respectively. Estimated intraoperative blood loss was 165ml (range, 50-500). There were two (11%) entries into major vessels during tumor excision, namely a segmental renal artery in one patient and a segmental renal vein in another. Both of these occurrences were managed laparoscopically. One patient necessitated laparoscopic reexploration for urine extravasation in the immediate postoperative period. All postoperative nuclear scans (available in 12 of 18 patients) showed functional kidney moiety. Mean split renal function was 38.6% (range, 24-50) on the operated side. Histopathological examination confirmed renal cell carcinoma in 14 (77.8%) of the patients. One (7.1%) patient had a positive surgical margin on the surface that was adjacent to the renal artery. In a median follow-up of 26 mo (range, 1-59), no local recurrence or systemic progression occurred. CONCLUSION: Laparoscopic partial nephrectomy for hilar tumors is a feasible and safe procedure in the hands of experienced laparoscopic surgeons. Oncological results seem excellent, but further follow-up is needed for accurate long-term assessment of this surgical approach.     

后腹腔镜肾部分切除术治疗肾脏小肿瘤的疗效及安全性评价

目的 探讨后腹腔镜肾部分切除术治疗肾脏小肿瘤的有效性和安全性.方法 回顾性分析28例后腹腔镜肾部分切除术及24例同期行开放性肾部分切除术患者的临床资料,比较两种术式在手术时间、术中估计出血量、术后镇痛药物使用剂量、胃肠道功能恢复时间、术后住院时间、并发症发生率及肿瘤学效果等方面的差异.结果 后腹腔镜组与开放手术组患者在性别、年龄、肿瘤位置及肿瘤大小上的差别无统计学意义.后腹腔镜组1例因动脉分支出血中转开放手术,其他手术均获成功.后腹腔镜组平均手术时间118.4±16.2 min较开放组手术时间102.3±22.4 min长,但二者之间差异无统计学意义.开放组术中估计出血量142±12 ml,后腹腔镜组估计出血量126±14 ml,二者差异无统计学意义.后腹腔镜组热缺血时间26.6±4.2 min,开放组16.5±1.8 min,组间差异显著.后腹腔镜组在镇痛药用量、胃肠道功能恢复时间、及术后住院日等方面明显均优于开放组(P<0.05).所有患者术后血肌酐均在正常水平.两组患者术后并发症的发生率相当(25.9%vs 16.7%),无术后大出血、尿瘘等严重并发症出现.平均随访时间17(1～30)个月,两组患者均未见肿瘤复发及转移.结论 与传统开放手术相比,后腹腔镜下肾部分切除术具有一定的技术难度,但仍是一种安全、有效的手术方式,而且具有创伤小、患者痛苦少、恢复快、住院时间短等优点.     

后腹腔镜下肾部分切除术(附4例报告)

目的 探讨腹腔镜肾部分切除术的可行性.方法 2005年8～11月对2例肾恶性肿瘤和2例肾错构瘤行腹腔镜肾部分切除术.先游离患肾,显露肾动、静脉及输尿管,棉带穿过肾动脉以备阻断患肾血流,行肾部分切除术,结果 4例手术均获成功,无中转开放手术.手术时间2例均为1.5h,1例2h,1例3h;术中出血50～180ml,均未输血.1例肾蒂阻断时间25min,余3例未完全阻断.结论 腹腔镜肾部分切除术技术可行.     

Laparoscopic partial nephrectomy using microwave tissue coagulator for small renal tumors: usefulness and complications

OBJECTIVES: We evaluated the usefulness and complications of laparoscopic partial nephrectomy for small renal tumors using a microwave tissue coagulator without renal pedicle clamping. METHODS: Between September 1999 and March 2003, 19 patients with small renal tumors 11 to 45 mm in diameter underwent laparoscopic partial nephrectomy without renal ischemia. RESULTS: Six and 13 patients were treated by the transperitoneal and retroperitoneal approaches, respectively. Excluding a case with open conversion due to dense perirenal adhesions, 18 patients successfully underwent laparoscopic procedures. The mean operative time was 240 minutes with minimal blood loss in 14 patients and 100 to 400 ml in 4. In a patient, frozen sections revealed a positive surgical margin and additional resection was performed. Postoperative complications included extended urine leakage for 14 days, arteriovenous fistula and almost total loss of renal function, respectively, in a patient. With the median follow-up of 19 months, no patients showed local recurrence or distant metastasis by CT scan. CONCLUSIONS: Laparoscopic non-ischemic partial nephrectomy using a microwave tissue coagulator may be useful for treating small renal tumors because it does not require advanced laparoscopic skill. However, the indication of this procedure should be highly selective in order to minimize serious complications secondary to unexpected collateral damage to surrounding structures.     

腹腔镜肾部分切除术

目的:探讨腹腔镜肾部分切除术临床应用的可行性。方法:为1例重复肾畸形患者行腹腔镜肾部分切除术。结果:手术顺利,无并发症,术后7d出院,恢复良好。结论:腹腔镜肾部分切除术具有患者创伤小,出血少,解剖清晰,康复快,并发症少等优点。     

Laparoscopic partial nephrectomy in infants and toddlers

Background/Purpose

The aim of this report is to assess the technique and outcome of laparoscopic partial nephrectomy in infants and toddlers.

Methods

From January 2001 to January 2005, 7 consecutive patients, ages 5 to 15 months, underwent laparoscopic partial nephrectomies. All patients had duplicated systems associated with ureteroceles (5), severe reflux (1), ectopic ureter (1), and nonfunctioning systems. Follow-up ranged from 4 to 51 months.

Results

All procedures were completed successfully using 4 ports (2 × 5 and 2 × 3 mm) except one, which required an additional port. The distal ureter, renal parenchyma, and hilar vessels were all transected using the harmonic scalpel. The mean operating time was 179 minutes with minimal blood loss in each case. The average hospital stay was 2.4 days (range, 1-5 days). The first case in the series, initially attempted retroperitoneally, was converted to a transabdominal approach because of lack of space. All subsequent approaches were transabdominal. One patient required ureteral stump reexcision because of frequent urinary tract infections associated with a distal ureteral diverticulum.

Conclusions

Laparoscopic partial nephrectomy can be performed safely. The harmonic scalpel divides the parenchyma bloodlessly. The cosmetic result is excellent. A transabdominal approach with division of the ureteral cuff flush with the bladder is recommended.     

术中超声辅助定位在后腹腔镜肾部分切除术的应用体会

目的探讨术中超声辅助定位在后腹腔镜肾部分切除术中的作用.方法回顾性总结2014年1月至2016年2月期间我们进行的后腹腔镜下肾部分切除术45例,术中先用超声刀在肿瘤区域预标记切缘为 A线,后经Trocar置入腔镜B超探头,行肿瘤区域扫描明确定位为 B线,比较术中 A线、B线的重叠情况,以两线最大差距≥2 mm为有差异,＜2 mm为重叠.按R．E．N．A．L．评分系统的5类进行独立评估分析.结果术中超声辅助定位能在后腹腔镜下明确瘤体生长姿势、边界及血供情况,引导切割方向以保证肿瘤包膜完整性,尤其在完全性内生肿瘤方面发挥更大的辅助效果.结论术中超声辅助定位在后腹腔镜肾部分切除术中具有较高的安全性,手术辅助效果明显.     

Laparoscopic partial nephrectomy: contemporary technique and outcomes

OBJECTIVES: Laparoscopic partial nephrectomy has emerged as a viable alternative to open partial nephrectomy while minimizing patient morbidity. In this article and accompanying video we describe our current technique of LPN and review our outcomes in specific patient sub-sets. METHODS: Since September 1999 more than 500 laparoscopic partial nephrectomies have been performed by the senior author. Data were collected prospectively. All patients underwent a three-dimensional CT scan prior to the operation. Our established technique involves preoperative ureteral catheterization, laparoscopic renal ultrasonography to delineate the tumor, en bloc clamping of the renal hilar vascular pedicle, tumor excision with cold endoshears, pelvicaliceal suture repair and parenchymal closure over Surgicel bolsters with biologic hemostatic agent. Renal hypothermia was achieved laparoscopically with ice slush in selected cases with anticipated long warm ischemia time. RESULTS: Mean tumor size was 2.9 cm (1-10.3 cm), 31% of the tumors were greater than 3 cm, 5% occurred in a solitary kidney, and tumor location was central in 40% and hilar in 6% of patients. Transperitoneal approach was employed in 65% of the cases. Mean warm ischemia time was 32 min. Intraoperative complications occurred in 5.5%. Pathology confirmed renal cell carcinoma in 75% of the tumors. In the initial 100 patients with a 3 years minimum follow-up, overall survival was 86% and cancer-specific survival was 100%. CONCLUSIONS: Laparoscopic partial nephrectomy is a technically challenging procedure. Adequate prior experience with laparoscopy is necessary. Long-term functional and oncological outcomes are being confirmed currently.     

达芬奇机器人辅助腹腔镜保留肾单位肾部分切除术的初步探索（附32例报告）

目的总结达芬奇机器人辅助腹腔镜保留肾单位肾部分切除术的手术经验,探讨此术式的疗效及安全性.方法回顾分析2015年10月至2016年6月在我院行达芬奇机器人辅助腹腔镜保留肾单位肾部分切除术的32例肾肿瘤患者(男16例,女16例)的临床资料.结果32例患者手术均成功完成,无中转开放手术.手术时间90~160 min,平均126 min;热缺血时间17~32 min,平均25 min;术中失血量50~200 ml,平均101 ml,无术中输血;无术中并发症.术后4 d 拔除引流管,术后住院7~10 d,平均8．5 d.术后病理检查均为肾透明细胞癌,肿瘤直径2~6 cm,平均3．3 cm,无1例切缘阳性.结论机器人辅助腹腔镜保留肾单位肾部分切除术是一种微创、安全、高效,疗效确切的手术方式.随着操作者经验的积累,此术式将具有更加明显的优势.