后腹腔镜下保留肾单位肾肿瘤切除术治疗早期肾癌的不同方法分析

摘要

Objective To observe the efficacy of 4 different surgical treatments of retroperitoneal laparoscopic nephron sparing surgery for patients with localized renal cell carcinoma and its effects for the postoperative renal function. Methods From January 2005 to December 2015,80 cases of patients with renal tumor which diameter was 4cm or less received retroperitoneal laparo-scopic nephron sparing surgery. According to the surgical method,they were divided into 4 groups:simple enucleation(group A,n=21),sequential method(group B,n=18),selective segmental renal artery clamping(group C,n=21)and renal artery clamping on demand(group D,n=20). The changes of glomerular filtration rate before and after operation were observed in 4 groups to determine the change of renal function. Results All the procedures were completed successfully without conversion to open surgery. The mean ischemic time was(11.5±2.5)min of 11 cases in group D and Radius Exophytic Nearness Anterior Lo-cation scores(R.E.N.A.L.)were greater than 7. The surgical margin was negative in all cases and there was no statistically significant difference in glomerular filtration rate between before and after surgery(P>0.05). The contralateral kidney tumor occurred in 1 case(1.25%)and the others were healthy during (22.0±15.8)months of follow-up. Conclusion The 4 different surgical treatments of retroperitoneal laparoscopic partial nephrecto-my for localized renal cell carcinoma are safe and effective. It can treat the most of renal cell carcinoma and reserve the postoperative renal function maximally.%目的 观察分析后腹腔镜下保留肾单位肾肿瘤切除方法的疗效及对患者术后肾功能的影响.方法 回顾性分析2008年1月至2015年12月,南京军区南京总医院泌尿外科收治的80例肾癌患者临床资料,肿瘤最大直径≤4.0 cm(T1a期),并施行后腹腔镜下保留肾单位肾肿瘤切除术.按手术方法将患者分为4组:A组(n=21)为单纯肾肿瘤剜除术,B组(n=18)为序贯法行肿瘤切除术,C组(n=21)为选择性肾段动脉阻断行肿瘤切除术,D组(n=20)为适时肾蒂或肾动脉阻断行肿瘤切除术.观察4组患者术前术后肾小球滤过率(GFR)的变化来判断各组患者术后肾功能的改变. 结果 施行后腹腔镜下保留肾单位肾肿瘤切除术的80例患者均手术成功,无一例中转开放手术.其中D组有11例患者术中阻断肾动脉,平均阻断时间(11.5±2.5)min,且患者R.E.N.A.L.评分均≥7分.术后标本切缘病理检测均为阴性,术前术后GFR的差异无统计学意义(P>0.05).术后平均随访(22.0±15.8)个月,除1例患者随访中发现对侧肾肿瘤生长(发生率1.25%),其余患者术后情况良好. 结论 4种后腹腔镜下保留肾单位肾肿瘤切除术治疗T1a期肾癌安全有效,能完成绝大部分肾肿瘤的切除,并且能最大限度地保护术后患肾功能.