49例后腹腔镜肾部分切除术的临床分析

摘要

目的 评价后腹腔镜肾部分切除术(retroperitoneal laparoscopic partial nephrectomy,RLPN)的安全性和临床效果.方法 回顾性分析福建医科大学附属协和医院5年来49例RLPN的临床资料.肿瘤位于左肾者23例,右肾者26例,肿瘤直径平均为3.9(1.5 ～6.3)cm.应用后腹腔镜下距肿瘤边缘0.5 ～1.0 cm处完整切除肿瘤.结果 49例患者手术均顺利完成,无中转开放及脏器损伤病例.平均手术时间82(45～ 130) min,平均热缺血时间27(13 ～40) min,术中平均出血量250(50 ～ 500) mL.术后病理确诊肾透明细胞癌35例、乳头状肾细胞癌2例、肾血管平滑肌脂肪瘤9例、嗜酸细胞瘤3例,肿瘤切缘均阴性.术后尿漏者1例,肾周血肿者1例,肾功能不全者1例,保守治疗后痊愈,平均住院时间9(7～12)d.随访时间4 ～ 49个月,未见肿瘤复发.结论 RLPN具有安全、出血少、恢复快、微创等优点,值得在具备条件的医院临床推广.%Objective To evaluate the safety and clinical efficacy of retroperitoneal laparoscopic partial nephrectomy (RLPN). Methods Forty-nine cases who underwent RLPN were analyzed retrospectively, the patients were followed up for five years. Tumors were on the left side in 23 cases and on the right in in 26. The mean tumor size was 3.9 (1.5 -6.3) cm in diameter. The tumor was resected with a margin of 5 to 10 mm of healthy renal parenchyma. Results All the operations were completed successfully, without conversion to open surgery and no organ injury occurred. Mean operating time was 82 (45 ~ 130 ) min, the mean warm ischemic time was 28 (18 ~40) min and mean estimated blood loss was 250 (50 ~ 500) mL. The pathological studies revealed 35 cases of clear cell carcinoma, 2 cases of papillary renal cell carcinoma ,9 cases of angioleiomyolipoma and 3 cases of renal oncocytoma. The surgical margin was negative in all cases. Urine leakage was found in 1 case, perinephric hematoma in 1 case, impaired renal function in 1 case, the incisions in all the cases were healed without secondary surgical invention. The mean hospital stay was 9 (7 -12) d. During 4 ~49 months of following up, there was no recurrence of tumor. Conclusion RLPN could be a safe and minimally invasive procedure, and it is worthy of promotion for qualified hospitals.