微波消融辅助后腹腔镜下肾部分切除术治疗中危肾肿瘤

吴小荣; 陈勇辉; 张进; 黄吉炜; 陈伟; 孔文; 薛蔚; 刘东明; 黄翼然

doi:10.13201/j.issn.1001-1420.2019.06.013

微波消融辅助后腹腔镜下肾部分切除术治疗中危肾肿瘤

- 上海交通大学医学院附属仁济医院泌尿科(上海, 200127)
基金项目:
上海申康发展中心三年行动计划专科疾病临床五新转化项目(编号16CR3062B)

上海交通大学医工交叉-青年基金项目(编号YG2017QN46)

上海交通大学医学院博士创新基金(编号CBXJ201804)

详细信息

通讯作者: 薛蔚,E-mail:xuewei@renji.com

中图分类号: R737.11

收稿日期: 2018-12-16

Microwave ablation assisted laparoscopic partial nephrectomy for renal carcinoma with intermediate risk PADUA score

- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China

More Information

Corresponding author: XUE Wei, E-mail: xuewei@renji.com

Received Date: 16 December 2018

摘要

摘要: 目的:应用微波消融辅助后腹腔镜肾部分切除术(MWA-LPN)治疗中危肾肿瘤(PADUA评分8~9分),以缩短肾脏热缺血时间,保护肾功能。方法:回顾性分析2014年1月~2017年8月我院收治中危肾肿瘤患者157例,79例行微波消融辅助后腹腔镜肾部分切除术(MWA-LPN组),另78例行腹腔镜肾部分切除术(LPN组),比较两组手术时间、热缺血时间、术中出血量、术后并发症、住院天数及肾功能等临床指标。结果:所有手术均获成功,无中转开放。MWA-LPN组和LPN组平均手术时间分别为(90.3±31.9) min、(100.9±23.2) min;平均热缺血时间分别为(10.6±4.1) min、(18.6±2.9) min;术后平均住院天数分别为(4.8±0.9) d、(5.5±1.3) d,两组比较差异均有统计学意义(P＜0.05)。MWA-LPN组和LPN组术中平均出血量分别为(132.8±66.7) ml、(129.5±142.4) ml,两组比较差异无统计学意义;两组术后切缘病理均阴性,Scr及eGFR比较差异无统计学意义。MWA-LPN组术后尿瘘1例,血尿1例,切口愈合不良1例,发热2例;LPN组术后尿瘘1例,血尿2例,发热2例,两组比较差异无统计学意义。本组随访12~55个月,平均(26.9±10.6)个月,未发现肿瘤局部复发及远处转移。结论:MWA-LPN具有热缺血时间短、术后恢复快等优点,是一种可供选择的安全、有效的治疗中危肾肿瘤术式,但其远期疗效尚需大样本对照研究和长期随访观察。
- 腹腔镜 /
- 肾肿瘤 /
- 肾部分切除术 /
- 微波消融
Abstract: Objective: We used microwave ablation assisted laparoscopic partial nephrectomy (MWA-LPN) to treat renal carcinoma with intermediate risk PADUA score to decrease the warm ischemia time and preserve the renal function. Method: From January 2014 to August 2017, 157 renal carcinoma patients with intermediate risk PADUA score were admitted in our hospital, among which 79 patients underwent MWA-LPN and the other 78 underwent LPN. The operative time, warm ischemia time, estimated blood loss, complications and hospital stay were compared between the two groups. Result: All patients were operated successfully without conversion to open surgery. The mean operation time was (90.3±31.9) min and (100.9±23.2) min for MWA-LPN and LPN group, respectively. The mean warm ischemia time was (10.6±4.1) min and (18.6±2.9) min, and the mean postoperative hospital stay was (4.8±0.9) d and (5.5±1.3) d for MWA-LPN and LPN group, respectively. The difference between the two groups was significant (P＜0.05). The mean estimated blood loss was (132.8±66.7) ml and (129.5±142.4) ml without statistical significance. All tumors were removed with negative surgical margin. The postoperative creatinine and eGFR were normal and there was no significant difference between two groups. Postoperative complications were found in MWA-LPN group including urinary leakage in 1 case, hematuria in 1 case, poor wound healing in 1 case and fever in 2 cases, while urinary leakage in 1 case, hematuria in 2 cases and fever in 2 cases in LPN group. There was no significant difference between two groups. During the mean follow-up period of (26.9±10.6) (range, 12-55) months, there was no tumor recurrence or metastasis in both groups.Conclusion: MWA-LPN has the advantages of short warm ischemia time and rapid recovery. It was a safe and effective treatment for renal carcinoma with intermediate risk PADUA score, but its long-term oncological efficacy needs proving by large sample control study and long-term follow-up.
- laparoscopy /
- renal neoplasm /
- partial nephrectomy /
- microwave ablation

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