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目的探讨后腹腔镜肾部分切除术治疗肾肿瘤的手术方法及临床疗效。方法选择7例肾肿瘤患者行后腹腔镜肾部分切除术。其中T1期肾癌6例,肾错构瘤1例。术中阻断肾动脉主干4例,选择性阻断肾段动脉3例。距肿瘤约1.0cm处,整块剪除肿瘤和部分肾实质及其表面的脂肪组织,分层缝合集合系统和肾实质后,解除阻断。观察手术时间、肾动脉或肾段动脉阻断时间、术中出血量及围术期并发症。结果 7例手术均成功完成,肿瘤包膜完整,术后切缘阴性。手术时间110～220min,平均155min;术中出血40～250mL,平均120mL。肾动脉阻断时间22～50min,平均35min,肾段动脉阻断时间16～28min,平均23min。术后随访1～9月,无继发出血,无漏尿,无肿瘤局部复发,总肾功能及分肾功能无异常。结论后腹腔镜肾脏部分切除术微创安全可行,控瘤效果好,保留的肾单位功能恢复好;选择性段动脉阻断的肾部分切除术,可期望得到最大限度的肾功能保留。
Objective To investigate the surgical methods and clinical effects of retroperitoneoscopic partial nephrectomy for renal tumors. Methods Seven cases of renal tumor underwent laparoscopic partial nephrectomy. T1 of which 6 cases of renal cell carcinoma, renal hamartoma in 1 case. Intraoperative blocking renal artery in 4 cases, selective blocking of renal artery in 3 cases. At a distance of about 1.0 cm from the tumor, the entire tumor was removed and part of the renal parenchyma and its surface of the adipose tissue, stratified suture collection system and renal parenchyma, the lifting of the block. Observation of operation time, renal artery or renal artery occlusion time, intraoperative blood loss and perioperative complications. Results All the 7 cases were completed successfully. The tumor capsule was complete and the negative margins after operation. Surgery time 110 ~ 220min, an average of 155min; intraoperative bleeding 40 ~ 250mL, an average of 120mL. Renal artery blocking time 22 ~ 50min, an average of 35min, renal artery blocking time 16 ~ 28min, an average of 23min. All the patients were followed up for 1 ~ 9 months. No secondary hemorrhage, no leakage of urine, no local recurrence of tumor, no abnormality of the total renal function and renal function. Conclusions Retroperitoneal laparoscopic partial nephrectomy is safe and feasible, with good tumor control effect and good retention of nephron function. Partial nephrectomy with selective segmental artery occlusion can be expected to maximize the retention of renal function.