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目的:探讨腹腔镜下保留肾单位肾部分切除术(LNSS)治疗肾肿瘤的可行性和疗效。方法:2010年3月~2012年3月行LNSS 73例,肿瘤直径1.5~6.0cm,平均4.3cm。术前诊断错构瘤12例,肾癌61例(临床分期T1a期55例,T1b期6例)。肿瘤位于左侧41例,右侧32例。肿瘤位于肾上极23例,肾下极19例,中部31例;肿瘤位于背外侧54例,腹侧19例,其中靠近肾门6例。合并高血压病17例,糖尿病9例,对侧肾结石5例,对侧肾萎缩1例,孤立肾1例。结果:手术均获成功,手术时间平均65min,术中出血平均30ml,热缺血时间平均24min。切除范围据肿瘤边缘正常肾脏组织0.5cm。7例术中发现集合系统损伤并行修补。术后病理提示错构瘤12例,透明细胞癌55例,嫌色细胞癌4例,乳头状细胞癌2例。术后病理切缘均阴性。术后腹膜后引流管留置7~9d,导尿管留置5~7d。1例术后继发性出血,给予高选择性肾动脉栓塞治疗。术后随访6~12个月,1例肺部转移,给予舒尼替尼靶向治疗,其余患者肿瘤无复发。结论:LNSS治疗直径小于7cm肾肿瘤安全有效。
Objective: To investigate the feasibility and efficacy of laparoscopic renal nephrectomy (LNSS) in the treatment of renal tumors. Methods: From March 2010 to March 2012, 73 cases of LNSS were performed. The tumor diameter was 1.5-6.0 cm, with an average of 4.3 cm. Preoperative diagnosis was 12 cases of hamartoma and 61 cases of renal cell carcinoma (55 cases with clinical stage T1a and 6 cases with T1b). The tumor was located on the left side in 41 cases and the right side in 32 cases. The tumors were located in the upper pole of the kidney in 23 cases, the lower pole of the kidney in 19 cases and the middle in 31 cases. The tumors were located in the dorsolateral area in 54 cases and in the ventral area in 19 cases, among which 6 cases were near the renal hilum. There were 17 cases of hypertension, 9 cases of diabetes, 5 cases of contralateral kidney stones, 1 case of contralateral kidney atrophy, and 1 case of isolated kidney. Results: All the operations were successful. The average operation time was 65 minutes. The intraoperative blood loss was 30 ml and the warm ischemia time was 24 minutes. The resection range was 0.5 cm from the normal kidney tissue at the edge of the tumor. In 7 cases, collective system damage was repaired in parallel. Postoperative pathology revealed 12 cases of hamartoma, 55 cases of clear cell carcinoma, 4 cases of chromophobe carcinoma, and 2 cases of papillary carcinoma. Postoperative pathological margins were negative. Postoperative retroperitoneal drainage tube indwelling 7 ~ 9d, catheter indwelling 5 ~ 7d. One case of secondary bleeding was treated with highly selective renal artery embolization. After 6 to 12 months of follow-up, 1 patient had lung metastasis and was given sunitinib for targeted therapy. The remaining patients had no recurrence of tumor. Conclusion: LNSS is safe and effective in treating renal tumors less than 7cm in diameter.