| 摘要: |
| 目的 评价经后腹腔镜联合经腰小切口及超声辅助下行中心型肾癌保留肾单位手术的临床疗效,总结手术经验。方法 回顾性分析2010年8月至2012年3月12例经后腹腔镜联合经腰小切口及超声辅助下行保留肾单位手术治疗中心型肾癌患者的临床资料。男9例、女3例,平均年龄(56.2±2.8) 岁；肿瘤平均直径(2.2±1.4) cm。术前均经超声、CT、MRI或CT动脉造影检查。患者全身麻醉后取健侧卧位,后腹腔镜常规方法游离出肾动脉、肾静脉及肾脏,切开腋后线与腋前线的两个Trocar之间的皮肤及肌肉,建立小切口,将超声探头从小切口置于肾表面,对肿瘤进行定位并标记手术切缘,放置冰屑于肾周,行肾动脉阻断或动、静脉阻断下保留肾单位手术。结果 12例手术均获成功,手术平均时间(124.5±5.8) min,术中平均热缺血时间(26.3±8.6) min,术中平均出血量(65.8±21.6) mL。切缘阴性率100%,平均手术切口(8.8±2.4) cm,术后平均住院时间 (12.4±2.6) d；术后无并发症发生。随访平均(13.6±7.4)个月,未见肿瘤复发及转移。结论 后腹腔镜联合经腰小切口及超声辅助下对中心型肾癌行保留肾单位手术具有创伤小、出血少、热缺血时间短、恢复快的优点,是一种安全、有效的治疗方法,具有良好的临床应用前景。 |
| 关键词: 肾肿瘤 腹腔镜检查 肾切除术 |
| DOI：10.3724/SP.J.1008.2013.00338 |
| 投稿时间：2012-11-02修订日期：2013-02-20 |
| 基金项目: |
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| Retroperitoneal laparoscopic partial nephrectomy combined with auxiliary small-incision and real-time B ultrasonic imaging in treatment of central renal cell carcinoma: a report of 12 cases |
| JI Jia-tao△,WANG Lin-hui△,LIU Bing,XU Bin,SUN Ying-hao* |
(Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
△Co-first authors.
*Corresponding author.) |
| Abstract: |
| Objective To evaluate the clinical efficiency of retroperitoneal laparoscopic partial nephrectomy combined with auxiliary small-incision and real-time B ultrasonic imaging in treatment of central renal cell carcinoma and to summarize the surgical experience. Methods The clinical data of 12 patients (9 males and 3 females) with central renal cell carcinoma, who were treated from Aug.2010 to Mar.2012, were retrospectively analyzed.The patients had a mean age of (56.2±2.8) years old and a mean tumor diameter of (2.2±1.4) cm. The patients underwent preoperative ultrasonograpy, CT, MRI or CT angiography. The renal artery, renal vein and kidney were separated under general anesthesia. A small incision was made between A(posterior axillary line) and B(anterior axillary line) Trocar. The tumor location and the operative margin were determined by auxiliary real-time B ultrasound placed on the kidney surface via the incision. Ice slush was scattered around the kidney and nephron-sparing operation was done after blocking renal artery.Results All the 12 cases were operated successfully and the renal tumors were removed completely,with the mean operation time being (124.5±5.8) min, mean warm ischemia time (WIT) being (26.3±8.6) min, mean blood loss being (65.8±21.6) mL, mean incision length being (8.8±2.4) cm, and mean postoperative hospital stay being (12.4±2.6) d.All the patients had a negative surgical margin and there were no severe perioperative complications. All the patients had normal renal function and had no tumor recurrence or metastasis during a mean follow-up of (13.6±7.4) months.Conclusion Retroperitoneal laparoscopic partial nephrectomy combined with auxiliary small-incision and real-time B ultrasonic imaging is safe and effective for treatment of patients with central renal cell carcinoma,with less trauma, less blood loss, shorter WIT, and faster recovery, and it has a promising clinical future. |
| Key words: kidney neoplasms laparoscopy nephrectomy |
