【摘要】 目的探讨后腹腔镜保留肾单位手术治疗肾肿瘤的可行性及临床效果。方法 2009年6月至2011年5月,共施行后腹腔镜保留肾单位手术21例,男13例,女8例,平均年龄43(21～58)岁。肿瘤均为单发,左侧12例,右侧9例,其中含孤立肾2例。肿瘤平均直径2.5(1.8～4.0)cm。7例良性肿瘤行剜除术,14例恶性肿瘤行楔形切除术。结果 21例手术均获成功。手术时间85～185min,中位数115min;肾脏热缺血时间17～29min,中位数25min。术中失血约55～450ml,中位数105ml。术中腹膜破裂2例,肾蒂周围小血管损伤出血3例,肾静脉破裂1例,术中即时缝合。术后病理示所有切缘均阴性。术后平均随访10(2～23)个月,全部无瘤生存,无1例局部复发或穿刺通道处发生种植转移。结论后腹腔镜保留肾单位术能安全、有效地治疗直径≤4.0cm的肾脏单发肿瘤。更多还原

【Abstract】 Objective To evaluate the feasibility and clinical efficacy of retroperitoneal laparoscopic nephron-sparing surgery for the treatment of small renal tumors.Methods Between June 2009 and May 2011,21 patients underwent retroperitoneoscopic nephron-sparing surgery at our institution.Of the 21 patients,13 were men and 8 were women.The mean age was 43 years(range 21 to 58).All patients had a solitary renal mass(among these patients 2 with a solitary kidney),12 tumors were on the left side and 9 were on the right.The mean tumor size was 2.5 cm in diameter(range 1.8 to 4.0 cm).7 patients with benign renal tumors underwent enucleation and 14 with malignant renal tumors underwent wedge resection,respectively.Results All cases were successfully operated.Median operative time was 115 min(range 85 to 185 min).Median warm ischemia time was 25 min(range 17 to 29 min).Median estimated blood loss was 105 ml(range 55 to 450 ml).Of all operations,peritoneum perforation occurred in 2 cases,and small vessel injuries were observed in 3 cases around renal pedicles,renal vein minor rupture in 1 patient which were sutured immediately.Margin was negative for all specimens.Mean follow-up of all 21 patients was 10 months(range 2 to 23),and no local recurrence and tumor seeding of port sites were found.Conclusions Retroperitoneal laparoscopic nephron-sparing surgery is an effective and feasible treatment regimen for the solitary renal mass,especially those less than 4 cm in size.更多还原