【摘要】 目的:探讨复杂肾囊性病变行腹腔镜肾部分切除术(LPN)的可行性和临床分型。方法:回顾性分析2015年12月～2018年2月我院诊治的复杂肾囊性病变21例,均行LPN。男8例,女13例;年龄28～65岁,平均44.5岁;囊肿直径2.5～5.5cm,平均3.7cm。Bosniak分型:Ⅰ型6例,ⅡF型7例,Ⅲ型6例,Ⅳ型2例。依据LPN的处理难度和病变的深浅位置进行临床分型:肾外突型10例,肾中央型5例,肾窦型2例,肾门型2例,混合型2例。结果本组21例患者均成功行LPN。手术时间50～135min,平均77.2min;肾动脉阻断时间10～30min,平均16.4min。手术前后肌酐无明显变化。术后病理结果显示:肾透明细胞癌18例,单纯肾囊肿3例,所有切缘阴性。结论:依据手术的处理难度和病变的深浅位置进行初步临床分型:肾外突型、肾中央型、肾窦型、肾门型和混合型。肾外突型需要保证切除干净和囊肿不破裂;肾中央型和肾窦型需要借助腹腔镜超声精确定位;肾窦型病变多需切破肾集合系统以保证切缘阴性;肾门型需要注意对肾动脉、肾静脉和肾盂的保护,需严密分层缝合,减少漏尿和出血等风险。更多还原

【Abstract】 Objective:To investigate the feasibility and clinical classification of complex cystic lesions treated with laparoscopic partial nephrectomy.Method:Between Dec 2015 and Feb 2018,twenty-one cases of complex renal cystic lesions treated with laparoscopic partial nephrectomy in our hospital were analyzed retrospectively.There were 8 males and 13 females,aged from 28 to 65(mean,44.5)years old.The diameter of the renal cyst was from2.5 to 5.5(mean,3.7)cm.There were 6 cases of typeⅠ,7 cases of typeⅡF,6 cases of typeⅢand 2 cases of typeⅣ according to the Bosniak classification.According to the difficulty of laparoscopic partial nephrectomy and the location of the cystic lesions,there were 10 cases of renal extraocular type,5 cases of centrally located type,2 cases of renal sinus type,2 cases of hilum type and 2 cases of mixed type.Result:Twenty-one patients were performed laparoscopic partial nephrectomy successfully.The operation time was from 50 to 135 min with an average of 77.2 min,and the intraoperative blood loss was from 10 to 150 ml,with an average of 37.6 ml.The renal artery occlusion time was from 10 to 30 min,with an average of 16.4 min,and there was no significant change in serum creatinine before and after operation.The pathological results were 18 cases of renal clear cell carcinoma and3 case of simple renal cyst,with all margins negative.Conclusion:According to the difficulty of the operation and the location of the cystic lesion,the complex cystic lesion can be divided into five groups,renal extraocular type,centrally located type,renal sinus type,renal hilum type and the mixed type.For the renal extraocular type,the complete removal of the complex cystic lesion without cyst rupture should be ensured.For the centrally located type and renal sinus type,laparoscopic ultrasound is needed for accurate positioning.For the renal sinus type,the renal collecting system might be cut off to ensure the complete removal of tumor.For the renal hilum type,it is of importance to protect the renal artery,renal vein and renal pelvis after careful dissection.For the mixed type,the management is similar to the type of renal sinus type and renal hilum type during surgery.更多还原