【摘要】 目的 探究后腹腔镜下保留肾单位手术在T1b期肾肿瘤中的可行性。方法 选取2016年2月至2020年2月就诊于本院的68例T1b期肾肿瘤患者为研究对象，均行后腹腔镜下保留肾单位手术治疗。统计入组后患者病理检查结果、围术期相关指标（术中出血量、热缺血时间、手术时间、术后引流量、住院时间、引流管留置时间）和术前、术后3个月肾功能及并发症发生情况。结果 68例T1b期肾肿瘤患者均顺利完成腹腔镜手术，无中转开放手术。术中出血量51～798 ml，平均（140.96±20.87）ml；手术时间98～221 min，平均（122.05±18.42）min；热缺血时间24～43 min，平均（30.21±3.45）min；术后住院时间5～15 d，平均（8.21±1.48）d；术后引流量79～551 ml，平均（180.65±76.27）ml；术后引流管留置时间2～7.8 d，平均（4.42±1.24）d。68例手术标本病理检查显示，肾嫌色细胞癌5例，肾透明细胞癌52例，肾血管平滑肌脂肪瘤7例，乳头状肾细胞癌4例。术前、术后3个月血尿素氮（BUN）、血肌酐（SCr）水平比较差异无统计学意义。术后24 h有1例患者有尿漏发生，膀胱镜下在患侧放置输尿管双J导管并留置导尿管，7 d后症状消失，无严重外科并发症发生；术后随访3个月，未见远处转移和肿瘤局部复发。结论 后腹腔镜下保留肾单位手术治疗T1b期肾肿瘤具有出血少、创伤小、并发症少、对肾功能无影响等优点，有利于手术恢复，且安全性高。更多还原

【Abstract】 Objective To explore the feasibility of retroperitoneal laparoscopic nephron-sparing surgery in T1b stage renal tumors. Methods A total of 68 patients with T1b renal tumors who were treated in our hospital from February 2016 to February 2020 were selected as the research subjects, and all of them underwent retroperitoneal laparoscopic nephron-sparing surgery. The pathological examination results, perioperative related indicators(intraoperative blood loss, warm ischemia time, operation time, postoperative drainage volume, hospitalization time, drainage tube indwelling time) and renal function and complications before and 3 months after surgery. Results All 68 patients with stage T1b renal tumors successfully completed laparoscopic surgery without conversion to open surgery. Intraoperative blood loss was 51-798 ml, average(140.96±20.87) ml; operation time was 98-221 min, average(122.05±18.42) min; warm ischemia time was 24-43 min, average(30.21±3.45) min; postoperative The hospital stay was 5-15 d, average(8.21±1.48)d; postoperative drainage volume was 79-551 ml, average(180.65±76.27) ml; postoperative drainage tube indwelling time was 2-7.8 d, average(4.42±1.24) d. Pathological examination of 68 surgical specimens showed that there were 5 cases of renal chromophobe carcinoma, 52 cases of renal clear cell carcinoma, 7 cases of renal angiomyolipoma, and 4 cases of papillary renal cell carcinoma. There was no significant difference in blood urea nitrogen(BUN)and serum creatinine(SCr) levels before surgery and 3 months after surgery. 1 patient had urine leakage 24 hours after operation. Double J ureteral catheter and indwelling catheter were placed on the affected side under cystoscope. The symptoms disappeared 7 days later, and no serious surgical complications occurred. The follow-up was 3 months after operation. Distant metastasis and local tumor recurrence were not seen. Conclusion Retroperitoneal laparoscopic nephron-sparing surgery for T1b stage renal tumors has the advantages of less bleeding, less trauma, less complications, and no impact on renal function, which is beneficial to surgical recovery and has high safety.更多还原