腹腔镜保留肾脏肾肿瘤切除术_医学论文.docVIP

腹腔镜保留肾脏肾肿瘤切除术_医学论文 腹腔镜保留肾脏肾肿瘤切除术_医学论文 作者：刘庆祚，高振利，张 鹏，王 琳，石 磊，孙德康，吴吉涛【摘要】 目的：探讨腹腔镜保留肾脏手术治疗肾肿瘤的临床应用价值。方法：为21例患者施行腹腔镜保留肾脏肾肿瘤切除术，其中13例经后腹腔途径，8例经腹腔途径，肿瘤直径2.5～4.0cm。术后病理为15例肾脏透明细胞癌(T1N0M0)，6例肾血管平滑肌脂肪瘤。结果：21例手术均获成功，手术时间80～130min，血管阻断时间10～35min，术中失血100～400ml，术后无出血、尿漏等重要并发症发生。术后短期随访所有透明细胞癌病例5～22个月无局部复发。结论：腹腔镜保留肾脏肾肿瘤切除术治疗早期肾脏肿瘤（直径≤4cm）安全有效，患者损伤小，康复快，值得临床推广应用。 【关键词】 肾肿瘤；保留肾脏手术；腹腔镜术 【Abstract】 Ｏbjective:To evaluate the clinical effect of laparoscopic nephronne patients with renal tumor were treated with retroperitoneal laparoscopic nephronsparing surgery,and the eight patients with laparoscopic nephronsparing surgery.The mean tumor size in diameter was 2.54.0cm.Considering the postoperative pathology,fifteen were clearcell cancinoma(T1N0M0),and six were angiomyolipoma of kidney.Results:All procedures were technically successful without conversion to open surgery in the twentyone patients.The mean operative time was 80130min and the time of the block of the blood vessel was 1035min,and the blood loss in the operation was 100400ml.No postoperative complication occurred such as haemorrhage or urinary fistula and so on.Neither local recurrence nor metastasis was observed during a follow up of 522 months.Conclusions:The laparoscopic nephronsparing surgery is feasible and safe for the selective patients with early renal tumors(the diameterlt4cm).This procedure has the advantages of precise and complete tumor excision,minimal invasion, less complications and shorter convalescence,and it is worth to extend in the clinic. 【Key words】 Kidney neoplasmsNephron 2004年10月至2007年3月我院采用腹腔镜保留肾脏肾肿瘤切除术治疗直径≤4cm的肾肿瘤患者21例，短期随访效果满意，现报道如下。 1 资料与方法 1.1 临床资料 本组21例中男14例，女7例,35～66岁，平均52.4岁。左侧13例，右侧8例。有症状者3例，其中2例轻微腰痛，1例间断发作肉眼血尿，体检发现14例，因其他疾病发现4例。术前均行B超、双肾CT平扫+增强检查。肿瘤直径2.0～4.0cm，平均2.8cm，未见淋巴结、肾血管、腔静脉受累的影像学证据，无肝、肺转移。 1.2 手术方法 1.2.1 经后腹腔途径手术 采用全身麻醉,患者取健侧卧位，于腋中线髂嵴上方做长约10mm的纵行切口，依次切开进入腹膜后间隙，置入自制扩张气囊，建立腹膜后操作空间。由此切口置入Trocar。第2穿刺点在腋后线十二肋缘下2cm与骶脊肌外侧缘1cm交叉处，第３穿刺点在肋缘下2cm与腋前线交叉处，第４穿刺点位于腋后线平脐水平，分别置入Troc