腹膜后入路腹腔镜肾段动脉阻断肾部分切除术治疗早期肾癌(附39例报道)

doi:10.3969/j.issn.1009-976X.2014.05.023

摘要/Abstract

摘要： 【摘要】〓目的〓评估腹膜后入路腹腔镜肾段动脉阻断肾部分切除术治疗早期肾癌的疗效、安全性。方法〓选择39例肾肿瘤患者,其中男28例,女11例,年龄39~86岁,平均58±3岁。其中左肾肿瘤20例,右肾肿瘤19例;所有均为单发。肾上极肿瘤 18例,下极肿瘤 12例,中部肿瘤9例。肿瘤最大径2.0~5.0 cm,平均3.5±0.6 cm。所有病例在临时阻断肾段动脉后,行腹膜后入路腹腔镜下肾部分切除术。统计手术时间、术中出血量、肾段动脉阻断时间及围术期并发症。结果〓39例手术均于后腹腔镜下顺利完成,手术时间65~110 min,平均85±16 min;肾段动脉阻断时间20~42 min,平均26±5 min;出血量10~50 mL,平均25 mL。无术后继发出血、尿外渗、种植;肾功能无显著变化。结论〓腹膜后入路腹腔镜肾段动脉阻断肾部分切除术治疗早期肾癌安全、效果确切;最大限度保护了肾功能,具有术野清晰、创伤小的优势。

关键词: 肾肿瘤, 腹腔镜, 肾部分切除术, 肾段动脉阻断

Abstract: 【Abstract】〓Objective〓To evaluate the curative effect and the safety of retroperitoneal laparoscopic partial nephrectomy with segmental renal artery clamping for small renal cancer. Methods〓Thirty-nine cases were selected, at the age of 39-86, the average age 58±3.20. Tumor occurred in the left kidney and right kidney had 20 cases and 19 cases, and all were solitary. Tumor located in the upper pole,lower pole arid middle kidney had 18,12,9 case,respectively. The maximum diameter of the tumor ranged from 2 to 5 cm, with an average of 3.5±0.6 cm. All the cases were underwent retroperitoneal laparoscopic partial nephrectomy with segmental renal artery clamping. Statistical data of operational duration, blood loss, renal segmentary artery blockage duration and pre-operative complications were gathered. Results〓Thirty-nine cases were completed smoothly under retroperitoneal laparoscope. The operation duration ranged 65-110 min, and the average duration was 85±16 min. The time of segmental renal artery occlusion ranged 20-42 min, and the average time was 26±5 min. The blood loss was 10-50 ml, and the average loss was 25 ml. The preliminary follow-up showed no secondary bleeding, urinous infiltration and implantation. No significant changes in renal function after surgery. Conclusion Retroperitoneal laparoscopic partial nephrectomy with segmental renal artery clamping for small renal cancer possesses the advantages of security, exact effect, maximum protection of renal function, with a clear surgical field, and small trauma.

Key words: Renal neoplasm, Laparoscope, Nephron-sparing surgery

中图分类号:

Ｒ737.1

陈南辉陈智林黄志成彭栋. 腹膜后入路腹腔镜肾段动脉阻断肾部分切除术治疗早期肾癌(附39例报道)[J]. 岭南现代临床外科, 2014, 14(05): 583-586.

Chen Nanhui, Chen Zhiling, Huang Zhicheng, Peng Dong. Retroperitoneal laparoscopic partial nephrectomy with segmental renal artery blocking for small renal cancer (Report of 39 cases)[J]. Lingnan Modern Clinics in Surgery, 2014, 14(05): 583-586.

参考文献

[1]孔垂泽, 等.肾细胞癌诊断治疗指南. 见: 那彦群, 叶章群等.主编,中国泌尿外科疾病诊断治疗指南[M],北京,人民卫生出版社.2014,3-13.
[2] Kattan MW, Reuter V, Motzer RJ, et al. A postoperative prognostic nomogram for renal cell carcinoma[J]. J Urol, 2001, 166(1): 63-67.
[3]李永生, 朱绍兴, 等. 保留肾单位手术与根治性肾切除术治疗小肾癌疗效的对照研究[J]. 中华肿瘤防治杂志, 2009,16（13）：1033-1035.
[4] Wright JL, Porter JR. Laparoscopic partial nephrectomy: comparison of transperitoneal and retroperitoneal approaches[J]. J Urol, 2005, 174 (3): 841-845.
[5]李晨光, 孙光, 等. 后腹腔镜和开放肾部分切除术的临床效果比较[J].中国内镜杂志, 2008, 14(8):789-791.
［6］邵鹏飞, 殷长军, 孟小鑫, 等．后腹腔镜下肾部分切除术治疗肾肿瘤的疗效评价[J]．中华泌尿外科杂志,2010,31(10)：658-661．
[7]殷民,林宁珠,等.高选择肾动脉阻断腹腔镜肾脏部分切除术治疗中央型肾肿瘤[J].临床泌尿外科杂志,2012,27（10）：741-743.
[8]郑军华, 彭波, 等. 腹腔镜保留肾单位手术治疗早期肾癌的临床研究（附32例报告）[J]. 中华腔镜泌尿外科杂志（电子版）,2008,2（4）：306-308.
[9]GILL I S, ABREU S C, DESAI M M, et al. Laparoscopic iceslush renal hypothermia for partial nephrectomy:the initial experience[J]. Clin Urol, 2003,170:52-56.
[10]JANETSCHEK G, ABDEIMAKSOUD A, BAGHEFFIF, et al. Lapamsocopic partial nephrectomy in cold ischemia:renal artery perfusion[J], Clin,Urol,2004,191:68-71.
［11］Simon J, Meilinger M, Lang H, et al. Novel technique for insitu cold perfusionin laparoscopic partial nephrectomy [J]. Surg Endosc, 2008,22 (10):2184-2189.
[12]Bhayani SB, Rha KH, Pinto PA, et a1. Laparoscopic partial ne-phrectomy: Effect of warm ischemia on serum creatinine[J]. JUrol,2004,172(4):1264-1266.
[13]王飞, 康新立, 等. 肾动脉阻断肾热缺血操作研究进展[J]. 临床泌尿外科杂志,2012, 27（10）：793-795.
[14]Becker F, Van Poppel H, Haakenberg O W, Srief C, Gill, Guazzoni G, et al. Assessing the impact of ischaemia time during parial nephrectomy[J]. Eur Urol,2009,56:625-634.
[15]邢念增, 王明帅, 等. 高选择性肾动脉分支阻断术在腹腔镜肾部分切除术中的应用[J]. 中华医学杂志, 2012, 92(18): 1275-1277.
[16]殷长军, 邵鹏飞, 等. 肾动脉阻断技术在腹腔镜肾部分切除术中的应用与技术要点分析[J]. 现代泌尿外科杂志, 2013,18(6): 532-534.
[17] Rosenblatt GS, Fuchs GJ. A comparison of running suture versus figure -8 sutures as the initial step in achieving hemostasis during laparoscopicpartial nephrectomy[J]. J Endourol, 2010, 24(3): 421-424.
[18] Kawa G, Kinoshita H, Komai Y, et al. Uninterrupted suturing of renal parenchyma in laparoscopic partial nephrectomy decreases renal ischemictime and intraoperative blood loss[J]. Int J Urol, 2010, 17(4): 382 -384.
[19]尚吉文, 邢念增, 等. Hem-o-lok结扎夹在腹腔镜肾部分切除术中的应用[J]. 临床泌尿外科杂志, 2008, 23（12）： 946-948.
[20] Seideman C, Park S, Best SL, et al. Self-retaining barbed suture for parenchymal repair during minimally invasive partial nephrectomy[J]. J En －dourol, 2011, 25(8): 1245-1247.
[21] Bylund JR, Clark CJ, Crispen PL, et al. Hand-assisted laparoscopic partial nephrectomy without formal collecting system closure: perioperativeoutcomes in 104 consecutive patients[J]. J Endourol, 2011 Aug 24.
[22] Duvdevani M, Laufer M, Kastin A,et al. Is frozen section anal-ysis in nephron sparing surgery necessary? A clinicopathologicalstudy of 301 cases[J]. J Urol, 2005, 173(2):385-387.
[ 23 ] Margulis V, Tamboli P, Jacobsohn K M,et al.Oncological eff-icacy and safety of nephron-sparing surgery for selected patientswith locally advanced renal cell carcinoma[J]. Nat Clin PractUrol, 2008, 5(6):296-297.

[1]	章纪豪, 萨拉木·米吉提, 曹彦龙, 汤浩泽, 卡哈尔·吐尔逊, 廖昊, 陈亚进, 陈捷. 关键安全视野理念在南疆地区腹腔镜胆囊切除术的应用研究[J]. 岭南现代临床外科, 2024, 24(04): 215-219.
[2]	刘国华, 吴家园, 钟国辉, 翟景威, 谭小宇. 预防性使用广谱抗菌药在减少胰十二指肠切除术后并发症中的价值探讨[J]. 岭南现代临床外科, 2024, 24(02): 93-99.
[3]	邓雪涌, 徐继威. 腹腔镜腹股沟疝修补术的研究进展及热点分析[J]. 岭南现代临床外科, 2024, 24(02): 136-140.
[4]	卢晓裕, 郑埕斌, 洪晓哲, 谢容明. 完全腹腔镜与腹腔镜辅助远端胃癌根治术的近期临床疗效对比：一项单中心前瞻性队列研究[J]. 岭南现代临床外科, 2023, 23(06): 455-459.
[5]	许耀鹏, 章聪, 柳弼仁, 李松, 陆轶杰, 蒋新卫, 吴建武. 三维可视化技术在腹腔镜胰十二指肠切除术中的应用研究[J]. 岭南现代临床外科, 2023, 23(05): 431-435.
[6]	李宇, 区活辉, 刘清波, 顾炽昌, 林杰, 马靖, 张伟杰, 王卫东. 选择性入肝血流阻断应用于腹腔镜肝切除术的临床策略[J]. 岭南现代临床外科, 2023, 23(03): 215-219.
[7]	雷丽, 吴岷翰, 杨志林, 霍景山. 外科夹致阑尾炎术后右下腹脓肿并腹壁窦道形成1例[J]. 岭南现代临床外科, 2023, 23(02): 190-192.
[8]	张宪光, 左超海, 余杰雄. 腹腔镜辅助腹直肌鞘阻滞在单孔腹腔镜胆囊切除术中的应用[J]. 岭南现代临床外科, 2023, 23(01): 6-9.
[9]	周小波. 腹腔镜胰十二指肠切除术的手术入路的研究进展[J]. 岭南现代临床外科, 2023, 23(01): 84-87.
[10]	罗发, 严庆, 陈焕伟. 腹腔镜肝切除治疗肝细胞癌的安全性和长期疗效观察[J]. 岭南现代临床外科, 2022, 22(05): 441-445.
[11]	刘小胜, 陈学彬, 马宁, 周太成, 陈双. 低温芒硝序贯疗法预防TAPP术后血清肿发生的疗效观察[J]. 岭南现代临床外科, 2022, 22(05): 475-479.
[12]	吉振帅, 谢程, 张鹏程, 蔡成宽, 支运来, 张志刚, 孙方浒. 目标性后腹腔镜下肾上腺病损切除术的学习曲线[J]. 岭南现代临床外科, 2022, 22(05): 497-502.
[13]	陈秋凯, 戴维. 吲哚菁绿在肝胆腹腔镜手术领域中的应用现状[J]. 岭南现代临床外科, 2022, 22(05): 520-525.
[14]	莫宇轩, 汤凌佳. 倒刺线缝合假性疝囊预防直疝术后血清肿应用研究[J]. 岭南现代临床外科, 2022, 22(04): 363-368.
[15]	潘佳仁, 潘华锋, 王平. 腹腔镜肾癌根治术后切口感染的手术室相关因素分析及术前NLR、PLR的意义[J]. 岭南现代临床外科, 2022, 22(03): 272-275.