腹腔镜保留肾脏肾肿瘤切除术.doc.docVIP

　　腹腔镜保留肾脏肾肿瘤切除术 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 nephronsparing surgery for treatment of the renal tumor. Methods:Thirteen of twentyone 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 diameterlt;4cm).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 neoplasms;Nephronsparing surgery;Laparoscopy 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