完全不阻断肾动脉腹腔镜肾部分切除术的可行性和安全性分析

马宏; 朱刚; 刘圣杰; 吴鹏杰; 逄城; 王建龙; 张耀光; 万奔

doi:10.13201/j.issn.1001-1420.2015.10.005

完全不阻断肾动脉腹腔镜肾部分切除术的可行性和安全性分析

- 北京医院泌尿外科(北京, 100730)

详细信息

通讯作者: 朱刚,E-mail:zhugang2000@gmail.com; 万奔

中图分类号: R737.11

收稿日期: 2015-05-26

Study on feasibility and safety of laparoscopic partial nephrectomy without renal artery clamping

- Department of Urology, Beijing Hospital, Beijing, 100730, China

More Information

Corresponding authors: ZHU Gang ; WAN Ben

Received Date: 26 May 2015

摘要

摘要: 目的:探讨一种完全不阻断肾动脉的腹腔镜肾部分切除术(LPN)的安全性、可行性和临床结果。方法:2014年6月~2014年12月我院为6例患者行完全不阻断肾动脉LPN。其中男4例,女2例,患者平均年龄54.5(38~79)岁。患者中位体重指数26.6(23.4~31.2) kg/m²。右侧肿瘤4例,左侧2例。肿瘤R.E.N.A.L.评分为4.3(4~5)分,平均肿瘤直径2.8(1.5~4.8) cm。术中在切除肿瘤之前,预先在肿瘤切除边缘的正常肾实质用带倒刺缝线进行缝合,适当力量吊起肾组织,以控制出血。在肿瘤与预先缝合之间用剪刀冷切除肿瘤。当肾部分切除创面出血时行创面肾实质缝合,重复此操作,直至完整切除肿瘤。最后完成肾创面缝合。结果:本组4例采用经腹途径完成,2例采用经后腹膜腔途径完成。所有患者均未阻断肾动脉,术中平均出血60.8(20~150) ml,平均手术时间106.7(65~130) min。无围手术期输血及严重并发症。平均术后住院时间4.3(2~6) d。术后病理4例为透明细胞癌,1例为复杂性肾囊肿,1例为肾错构瘤,外科切缘均为阴性。结论:完全不阻断肾动脉LPN对经选择的患者是一种安全有效的技术,该技术可以通过避免肾热缺血时间而保护肾功能。
- 肾肿瘤 /
- 肾部分切除术 /
- 热缺血 /
- 肾功能
Abstract: Objective:To evaluate the safety and feasibility of laparoscopic partial nephrectomy (LPN) without renal artery clamping.Method:From Jun. 2014 to Dec. 2014, six renal tumor cases including four males and two females accepted LPN without renal artery clamping. Average patients' age was 54.5 (range, 38-79) years old. The average BMI was 26.6 (range, 23.4-31.2) kg/m². There were four tumors on right kidney, and two tumors on left kidney. The R.E.N.A.L. score was 4.3 (range, 4-5). In the technique, the normal kidney tissue parenchyma adjacent to the tumor was sutured with barbered 2-0 V-loc suture and suspended slightly to reduce the bleeding during the resection of tumor. The tumor resection was carried out between the tumor edge and the preplaced suture and continued along the excision margin until some bleeding was encountered. If bleeding occurred, suture would be put on the bleeding site till the complete removal of the tumor. And in the end, the kidney was repaired to achieve complete hemostasis.Result:Four cases were performed by transperitoneal approach and two cases were performed by retroperitoneal approach. All the procedures were completed without renal artery clamping, thus no patient experienced warm ischemia. The average estimated blood loss was 60.8 (range, 20-150) ml, and average operating time was 106.7 (range, 65-130) min. There was no perioperative blood transfusion or Clavien 3 or 4 complication. The postoperative stay was 4.3 (range, 2-6) d. Pathology showed four cases of renal cell carcinoma (RCC), one case of complex renal cyst and one case of angiomyolipoma. All the cases were surgical margin negative.Conclusion:LPN without renal artery clamping is safe and feasible in selected cases. It can further protect renal function by omitting warm ischemia.
- renal tumor /
- partial nephrectomy /
- warm ischemia /
- renal function

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