目的:评估经后腹腔镜下保留肾单位手术在早期肾细胞癌治疗中的可行性和临床疗效.方法:对53例早期肾细胞癌患者实施后腹腔镜肾部分切除术.术前均行CT扫描和彩色超声检查,肿瘤直径最大不超过3cm,且距离集合系统不小于10mm.结果:53例手术均顺利完成,无中转开放手术者.平均手术时间为96(75-110) min;平均热缺血时间为15 (10～21) min,平均术中出血量70 (40-120) mL.术后平均住院4.2 (3～6)d.术中及术后无出血、漏尿等并发症.病理检查示1例患者肾透明细胞癌切缘阳性,余切缘均为阴性.平均随访39个月,所有患者未见肿瘤局部复发及转移.结论:后腹腔镜肾部分切除术治疗早期肾肿瘤安全可行,并且可以获得良好的治疗效果.%Objective:To evaluate the feasibility and clinical efficacy of retroperitoneal laparoscopic nephronsparing surgery for renal cell carcinoma of the early stage.Methods:Between June 2003 and June 2008,53 patients (31 males and 22 females) with renal mass were selected to undergo wedge resection of the tumor through retroperitoneal laparoscopy.Spiral computerized tomography (CT) and color Doppler ultrasound were used to provide information for nephron-sparing surgery (NSS).Patients with small (≤3 cm),peripheral,shallow and exophytic tumors,at a distance which exceeded approximately 10 mm between the tumor and renal collecting system,were enrolled into our studies.Surgical resection was performed along a resection line about 0.5 cm from the tumors.Results:All procedures were technically successful.Mean operating time was 96 min (ranging from 75 to 110 min).Mean warm ischemia time was 15 min (ranging from 10 to 21 min).Mean estimated blood loss was 70 m L (ranging from 40 to 120 mL).Mean hospital stay after the surgery was 4.2 days (ranging from 3 to 6 days).No intraoperative or postoperative complications occurred.Of 53 patients,52 had negative surgical margins and a 63-year male patient had a positive surgical margin.Neither local recurrence nor trocar-site metastasis was observed in the 53 patients during followups averaging 39 months (ranging from 11 to 83 months).Conclusion:Under the modified techniques of the surgery and conservative criteria for patient selection,laparoscopic partial nephrectomy can be safely and effectively performed and satisfactory outcomes are achievable.
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