应用单极电凝免缝合腹腔镜肾部分切除术手术技巧与要点(附光盘)

摘要

腹腔镜肾部分切除术目前已经成为小肾肿瘤最重要的治疗手段.传统经典的肾部分切除术主要包括3个步骤:肾脏血管的阻断、肿瘤的完整切除、肾实质的缝合.每一步骤都会对术后肾功能的恢复产生影响.而其中肾实质的缝合可能是肾功能损失的重要因素.单极电凝的免缝合技术在腹腔镜肾部分切除术中的应用,在保护肾功能同时降低了腹腔镜手术中的缝合学习曲线.本文主要探讨单极电凝的免缝合肾部分切除术的手术适应证、手术步骤、手术要点以及并发症的预防处理.应用单极电凝的免缝合腹腔镜肾部分切除术是安全可行的,对于较小的肾肿瘤(一般＜3 cm)的外生性的肾肿瘤,可以完成零缺血的手术.%Laparoscopic partial nephrectomy (LPN) has become the first choice in the treatment of small renal tumor.There are three steps in the classical LPN techniques,including clamping the renal vessels,excising the tumor,and suturing the renal parenchyma.Every step,especially the suturing process,affects the postoperative renal function.In this paper,we present our experiences of sutureless LPN using monopolar coagulation,which can preserve the renalfunction and reduce the learning curve,and discuss the indications,steps,techniques,key points and complications of the surgical approach.Based on our experience,we draw the conclusion that sutureless LPN using monopolar coagulation is safe and feasible;when the exophytictumor is less than 3 cm,zero ischemia LPN is favored.