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目的完善相关术前评估并取得患者知情同意后,完成国内首例经脐单孔腹腔镜下肾肿瘤冷冻消融术,并探讨该手术的可行性和安全性,总结操作经验,评价手术疗效。方法 2012年9月15日我科顺利完成经脐单孔多通道(TriPortTM)腹腔镜下肾癌冷冻消融术1例。患者59岁男性,BMI24.5kg/m2,肿瘤位于左肾,最大径2.1cm,术前血肌酐及左右侧GFR分别为:100μmol/L、37.2ml/min和34ml/min。于脐上缘取一2cm半弧形皮肤切口,充分游离暴露肿瘤表面,腹腔镜监视下将1把2mm直角冷刀经皮穿刺后置入瘤体内,按照EndoCare冷刀手术操作系统完成两个循环后退出冷冻刀头。结果手术顺利完成,手术时间、冷冻时间、术中出血分别为:120min、30min和30ml。术后前3d患者视觉疼痛模拟评分分别为:1、1和0分。术后住院时间5d,无任何手术相关并发症。术后病理组织学评估为透明细胞癌,Furhman分级为Ⅱ级。术后4周复查血肌酐及左右侧GFR分别为:97μmol/L、36.1ml/min和34.8ml/min。术后1周、4周复查肾脏增强CT提示局部完全失去对比剂增强,肿瘤已完全消退,无局部复发。结论初步经验表明经脐单孔腹腔镜下肾肿瘤冷冻消融术安全、可行,术后患者疼痛轻、恢复快、切口小、肾功能损害小、肿瘤治疗近期疗效确切。但其远期疗效有待前瞻性大样本的长期随访对照研究。
Objective To improve the related preoperative evaluation and obtain the informed consent of patients, to complete the first case of single-hole laparoscopic transabdominal renal cryoablation and to investigate the feasibility and safety of the operation, summarize the operational experience to evaluate the efficacy of surgery. Methods On September 15, 2012, 1 patient underwent laparoscopic renal cryoablation via TriPortTM. The patient was 59 years old and had a BMI of 24.5 kg / m2. The tumor was located in the left kidney with a maximum diameter of 2.1 cm. The preoperative serum creatinine and left and right GFR were 100 μmol / L, 37.2 ml / min and 34 ml / min, respectively. Take a 2cm semi-curved skin incision on the upper edge of the umbilical cord to fully expose the surface of the tumor. A 2mm right-angle cold knife was percutaneously punctured into the tumor after laparoscopic monitoring. Two cycles were completed according to the EndoCare cold knife operating system After leaving the frozen head. Results The operation was successfully completed. The operation time, freezing time and intraoperative bleeding were 120min, 30min and 30ml respectively. Visual acuity scores for the first 3 days after surgery were 1, 1, and 0 points, respectively. Postoperative hospital stay 5d, without any surgery-related complications. Postoperative histopathological evaluation of clear cell carcinoma, Furhman grade Ⅱ. Four weeks after operation, serum creatinine and left and right GFR were examined at 97μmol / L, 36.1ml / min and 34.8ml / min, respectively. After 1 week, 4 weeks review of renal enhanced CT prompt local complete loss of contrast enhanced, the tumor has subsided completely, no local recurrence. Conclusion Preliminary experience shows that cryoablation of single renal pelvic laparoscopic nephrectomy is safe and feasible. Postoperative patients have less pain, faster recovery, less incision and less renal damage. The curative effect of tumor treatment in the near future is accurate. However, its long-term efficacy remains to be seen in long-term follow-up of prospective, large-scale trials.