射频辅助后腹腔镜下肾部分切除治疗肾肿瘤的临床应用

摘要

目的 评价腹腔镜下射频消融辅助保留肾单位肾部分切除术治疗肾脏肿瘤的临床效果.方法 自2008年3月～2009年12月期间,有10例患者采用了射频辅助腹腔镜下肾部分切除术治疗肾脏肿瘤.其中肾细胞癌6例(肿瘤直径2.0～4.5 cm,平均2.3 cm),肾脏错构瘤4例(肿瘤直径3.5～6.0 cm,平均4.2 cm).均经后腹腔镜途径先显露肿瘤然后射频,<3 cm的肿瘤射频1个周期(12 min),>3 cm的肿瘤行射频24～36 min.射频消融后再沿肿瘤的边缘将肿瘤锐性切除,肿瘤基底采用电凝止血,出血明显的予以射频止血(2～4 min).结果 10例手术均获成功,无中转开放.手术时间63～95 min(平均71 min),术中出血50～150 mL(平均100 mL),无术后出血、无尿瘘、肾盂输尿管狭窄等并发症发生.术后住院3～5 d(平均3.5 d),随访时间3～18个月(平均10个月),尚未发现肿瘤局部复发或者远处转移.结论 射频消融辅助后腹腔镜下保留肾单位肾部分切除术治疗肾肿瘤出血少,无需腹腔镜下缝合止血,明显缩短了手术时间.%Objective To assess the efficacy and clinical feasibility of laparoscopic radiofrequency ablation ( RFA) assisted partial nepnrectomy for localized renal tumors. Methods From March 2008 to Dec. 2009, laparoscopic RFA assisted partial nephrectomy was performed for 10 renal tumors, of which 6 were renal cell carcinoma (size ranging 2. 0～4. 5 cm, mean 2. 3 cm) , and 4 were renal angiomyolipoma (size ranging 3. 5～6.0 cm, mean 4 . 2 cm) . All procedures were conducted through retroperitoneal approach, a single cycle of RFA (12 min) for tumors≤3 cm, and 2 or 3 cycles for tumors≥3 cm. The tumor was excised after RFA, and extra RFA (24～ min) was applied if there was obvious bleeding. Results All the lO cases were successful. The operative time was 63～95 min (mean 71 min) and blood loss 50～150 mL (mean 100 mL) . No complications occurred. Postoperative hospitalization time was 3～5 days (mean 3. 5 days) , and the follow-up was 3～18 months ( mean 10 months). Conclusions Laparoscopic radiofrequency ablation assisted partial nephrectomy is effective for localized renal tumors, with the advantages of less blood loss, short operatiVe time and a relatively short learning curve.