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| 后腹腔镜辅助小切口肾部分切除术治疗R.E.N.A.L.评分≥7的肾肿瘤 |
| 王林辉△,杨庆△,刘冰△,徐斌,吴震杰,叶华茂,纪家涛,程欣,孙颖浩* |
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(第二军医大学长海医院泌尿外科,上海 200433
△共同第一作者
*通信作者) |
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| 摘要: |
| 目的 分析后腹腔镜辅助小切口完成R.E.N.A.L.评分≥7肾肿瘤肾部分切除术的安全性和可行性,评价手术疗效,探讨临床应用价值。方法 2011年1月至2012年11月R.E.N.A.L.评分≥7肾肿瘤后腹腔镜辅助小切口肾部分切除术的患者19例,其中男性10例、女性9例,年龄(48.5±14.0)岁,体质指数(24.0±2.6) kg/m2,ASA评分(1.9±0.4),Charlson全身合并症指数(age-weighted) 0.6±0.2,肿瘤侧别(左/右) 11/8,肿瘤最大径(3.3±1.2) cm,肾肿瘤R.E.N.A.L.评分(8.6±0.9),术前估算肾小球滤过率(eGFR)(104.8±24.0) mL/(min·1.73 m2)。后腹腔镜下分离保留肾动静脉、肾周及肾脏肿瘤后,沿肋缘下两穿刺口连线作切口,阻断肾蒂,冰屑降温,切除肿瘤,缝合重建,完成手术。观察术中、术后情况并进行随访,评价手术疗效。结果 19例患者手术均顺利完成,无任何术中并发症,无术中输血,手术时间(220.2±57.5) min,术中出血(252.6±182.9) mL,肾脏冷缺血时间(25.2±6.6) min,手术切缘均为阴性。患者恢复顺利,术后住院时间(11.4±3.4) d。病理学检查提示：肾癌15例,血管平滑肌脂肪瘤2例,其他2例。术后随访(13.1±6.7)个月,19例患者均存活,无一例出现局部肿瘤复发或远处转移,eGFR(90.4±17.0) mL/(min·1.73 m2),与术前相比差异有统计学意义(Z=-3.099, P=0.002)。结论 对于复杂程度较高的局限性肾肿瘤,后腹腔镜辅助分离小切口肾部分切除术安全、可行、有效,结合了开放手术和传统腹腔镜手术的优势,扩大了保留肾单位手术的临床适应证,操作简便、费用低,值得进一步推广运用。 |
| 关键词: 肾肿瘤 保留肾单位手术 腹腔镜检查 小切口 |
| DOI：10.3724/SP.J.1008.2013.00655 |
| 投稿时间：2013-02-21修订日期：2013-04-19 |
| 基金项目:上海市市级医院新兴前沿技术联合攻关项目(SHDC12010115),军队临床高新技术重大项目(2010gxjs057),上海市重点学科项目. |
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| Retroperitoneal laparoscopic-assisted mini-incision partial nephrectomy for renal tumor patients with R.E.N.A.L. score≥7 |
| WANG Lin-hui△,YANG Qing△,LIU Bing△,XU Bin,WU Zhen-jie,YE Hua-mao,JI Jia-tao,CHENG Xin,SUN Ying-hao* |
(Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
△Co-first authors.
*Corresponding author.) |
| Abstract: |
| Objective To assess the safety, feasibility and efficacy of retroperitoneal laparoscopic-assisted mini-incision partial nephrectomy in treatment of R.E.N.A.L. tumors with R.E.N.A.L. score ≥7, and to evaluate its clinical significance. Methods Between January 2011 and November 2012, retroperitoneal laparoscopic-assisted mini-incision partial nephrectomy was performed in 19 R.E.N.A.L. tumor patients with R.E.N.A.L. score ≥7 at our institution. The information of patients was: male/female, 10/9; age (48.5±14.0) years old; body mass index (24.0±2.6) kg/m2; ASA score (1.9±0.4); Charlson co-morbidity index (age-weighted) 0.6±0.2; tumor laterality (L/R) 11/8; maximal diameter (3.3±1.2) cm; R.E.N.A.L. nephrometry score 8.6±0.9; and preoperative estimated glomerular filtration rate (eGFR) (\[104.8±24.0\] mL/\[min·1.73 m2\]). The R.E.N.A.L. pedicle, involved kidney and tumors were exposed by retroperitoneal laparoscopic techniques. A mini-incision was made along the line between the two original subcostal trocar sites. The R.E.N.A.L. pedicle was clamped and ice-slush surface cooling of the kidney was given, by then the tumor resection and R.E.N.A.L. defect reconstruction was finished. Results All the 19 cases were smoothly finished without any intraoperative complications or blood transfusion. The operative time was (220.2±57.5) min, estimated blood loss was (252.6±182.9) mL, R.E.N.A.L. ischemia time was (25.2±6.6) min, and all surgical margin was negative. The recovery was smooth, with a mean postoperative hospital stay of (11.4±3.4) days. Pathological examination revealed 15 cases of R.E.N.A.L. carcinoma, 2 angiomyolipoma, and 2 others. All the patients were alive after a mean follow-up of (13.1±6.7) months, without local recurrence or distant metastasis. Nevertheless, the eGFR was significantly decreased from (104.8±24.0) to (90.4±17.0) mL/(min·1.73 m2) after operation (Z=-3.099, P=0.002). Conclusion Retroperitoneal laparoscopic-assisted mini-incision partial nephrectomy is a safe, feasible and effective alternative for surgical management of complex localized R.E.N.A.L. tumors. It has the combined advantages of open operation and conventional laparoscopic partial nephrectomy, with less surgical demanding and lower cost, and is therefore deserve further popularization. |
| Key words: kidney neoplasms nephron-sparing surgery laparoscopy mini-incision |
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