后腹腔镜肾部分切除术治疗复杂性肾肿瘤的经验总结
Experience of Retroperitoneal Laparoscopic Partial Nephrectomy in the Treatment of Complex Renal Tumors
摘要: 目的：探讨后腹腔镜下肾部分切除治疗复杂性肾肿瘤手术技巧并总结经验。材料和方法：回顾性分析2018年4月至2020年5月青岛大学附属医院收治的68例行后腹腔镜下肾部分切除术治疗复杂性肾肿瘤患者的临床资料。男性41例，女性27例；左侧31例，右侧37例；患者年龄26~67岁，平均56.8岁，体质指数(Body Mass Index, BMI) 19.8~30.8 kg/m2，平均24.6 kg/m2，肿瘤直径3.0~6.3 cm，平均4.4 cm，R.E.N.A.L.评分7~10分，平均8.4分。结果：68例后腹腔镜肾部分切除术均顺利完成，未中转开放及肾根治术，手术时间55~160 min，平均76.8 min，手术出血量30~400 mL，平均75.8 mL，阻断肾动脉时间14~33.5 min，平均19.8 min，术后住院时间2~7 d，平均3.2 d，病理：肾透明细胞癌44例；乳头状肾癌9例；嗜酸细胞瘤4例，嫌色细胞癌4例；血管平滑肌脂肪瘤7例；1 (1.5%)例切缘阳性。随访3~26个月，均未出现局部转移及复发。结论：后腹腔镜下肾部分切除术治疗复杂性肾肿瘤安全可行的，但推荐在经验丰富的中心开展。
Abstract: Objective: To explore the surgical skills of retroperitoneal laparoscopic partial nephrectomy in the treatment of complex renal tumors and summarize the experience. Materials and Methods: The clinical data of 68 patients with complex renal tumors treated by retroperitoneal laparoscopic partial nephrectomy in the affiliated Hospital of Qingdao University from April 2018 to May 2020 were analyzed retrospectively. There were 41 males and 27 females, 31 on the left and 37 on the right, the age of the patients was 26 - 67 years old, the average age was 56.8 years, the Body Mass Index was 19.8 - 30.8 kg/m2, the average was 24.6 kg/m2, the diameter of the tumor was 3.0 - 6.3 cm, the average was 4.4 cm. The R.E.N.A.L. score was 7 - 10, with an average of 8.4. Results: All the 68 cases of retroperitoneal laparoscopic partial nephrectomy were completed successfully without conversion to open and radical nephrectomy. The operation time was 55 - 160 minutes (mean 76.8 minutes), the operative blood loss was 30 - 400 mL (mean 75.8 mL), the warm ischemia time was 14 - 33.5 minutes (mean 19.8 minutes), and the postoperative hospital stay was 2 - 7 days (mean 3.2 days). Pathology: renal clear cell carcinoma (n = 44), papillary renal carcinoma (n = 9), oncocytoma (n = 4), chromophobe cell carcinoma (n = 4) and angiomyolipoma (n = 7). The incisal margin was positive in 1 (1.5%) case. During the follow-up of 3 - 26 months, there was no local metastasis or recurrence. Conclusion: Retroperitoneal laparoscopic partial nephrectomy is safe and feasible for the treatment of complex renal tumors, but it is recommended to be carried out in experienced centers.
文章引用：李晨, 赵凯, 王振林, 张宗亮, 朱冠群, 张玉莲, 隋元明, 李雪禹, 王科. 后腹腔镜肾部分切除术治疗复杂性肾肿瘤的经验总结[J]. 临床医学进展, 2020, 10(12): 2906-2911. https://doi.org/10.12677/ACM.2020.1012439

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