后腹腔镜保留肾单位手术治疗T<sub>1b</sub>期肾癌的疗效观察

周海滨; 唐青; 廖鑫鑫; 黄玉清; 张良; 曾泉

后腹腔镜保留肾单位手术治疗T_1b期肾癌的疗效观察

- 九江学院附属医院泌尿外科(江西九江, 332000)

详细信息

通讯作者: 周海滨,E-mail:doczhou@126.com

中图分类号: R737.11

收稿日期: 2013-06-05

Retroperitoneal laparoscopic nephron-sparing surgery in treatment for patients with T_1b renal cell carcinoma

- Department of Urology, Affiliated Hospital of Jiujiang College, Jiujiang, Jiangxi, 332000, China

More Information

Corresponding author: ZHOU Haibin, E-mail: doczhou@126.com

Received Date: 05 June 2013

摘要

摘要: 目的：探讨后腹腔镜保留肾单位手术（NSS）治疗T_1b期肾癌（RCC）的手术方法及临床疗效。方法：2009年2月~2012年2月，对5例临床分期为T_1b期RCC患者行后腹腔镜NSS，其中男3例，女2例，平均年龄（55.4±9.6）岁，左侧3例，右侧2例。肿瘤平均直径（5.7±1.3） cm。结果：所有手术均顺利完成，无中转开放，围手术期无严重并发症。平均手术时间（110.0±29.5） min，术中平均热缺血时间（24.2±5.1） min，术中平均出血量（42.2±13.1） ml，术后尿漏1例；术后平均住院时间（5.9±2.1） d，术后平均随访（25.3±11.1）个月，全部患者肾功能正常且未见肿瘤局部复发及远处转移。结论：后腹腔镜NSS治疗T_1b期RCC创伤小、出血少、并发症少且近期疗效满意；但其远期疗效还需大样本对照研究和长期随访观察。
- 肾癌 /
- 后腹腔镜 /
- 保留肾单位手术
Abstract: Objective: To study the operation method and clinical effect of retroperitoneal laparoscopic nephron-sparing surgery in treatment for patients with T_1brenal cell carcinoma (RCC).Method: From February 2009 to February 2012, five patients (three males and two females) with T_1bRCC underwent retroperitoneal laparoscopic nephron-sparing surgery. Mean age was (55.4±9.6) years old, including three cases on the left side and two cases on the right side. The average diameter of the tumors was (5.7±1.3) cm.Result: All the operations were accomplished successfully without conversion to open surgery and no serious complications occurred. The average operation time was (110.0±29.5) min, the mean warm ischemia time was (24.2±5.1) min, and the mean volume of intraoperative bleeding was (42.2±13.1) ml. Urinary leakage was found in one case postoperatively. The average postoperative hospital stay was (5.9±2.1) d. All patients had normal renal function and had no tumor local recurrence and distant metastasis during a mean follow-up period of (25.3±11.1) months.Conclusion: Retroperitoneal laparoscopic nephron-sparing surgery is a recommendable approach with minimally invasion, less bleeding, fewer complications. It's effective for the patients with T_1bRCC. However, clinical controlled trials, observational studies and long-term follow-up plan in large samples are needed.
- renal cell carcinoma /
- retroperitoneal laparoscopy /
- nephron-sparing surgery

HTML全文

参考文献(14)

[1]	Mitchell R E, Gilbert S M, Murphy A M, et al. Partial nephrectomy and radical nephrectomy offer similar cancer outcomes in renal cortical tumors 4 cm or larger[J]. Urology, 2006, 67(2):260-264.
[2]	郭应禄, 周利群译. 坎贝尔-沃尔什泌尿外科学[M]. 北京:北京大学医学出版社, 2009:1700-1706.
[3]	那彦群,叶章群,孙光主编. 中国泌尿外科疾病诊断治疗指南[M]. 北京:人民卫生出版社, 2011:4-16.
[4]	Chen X S, Zhang Z T, Du J, et al. Optimal surgical margin in nephron-sparing surgery for T1b renal cell carcinoma[J]. Urology, 2012, 79(4):836-839.
[5]	Ljungberg B, Cowan N C, Hanbury D C, et al. EAU guidelines on renal cell carcinoma:the 2010 update[J]. Eur Urol, 2010, 58(3):398-460.
[6]	Venkatesh R, Weld K, Ames C D, et al. Laparoscopic partial nephrectomy for renal masses:effect of tumor location[J]. Urology, 2006, 67(6):1169-1174; discussion 1174.
[7]	Breda A, Stepanian S V, Lam J S, et al. Use of haemostatic agents and glues during laparoscopic partial nephrectomy:a multi-institutional survey from the United States and Europe of 1347 cases[J]. Eur Urol, 2007, 52(3):798-803.
[8]	张东旭, 李勋钢, 徐丹枫, 等. 后腹腔镜肾部分切除术治疗T1b期肾癌[J]. 第二军医大学学报, 2012, 33(4):454-456.
[9]	尚吉文, 邢念增, 闫勇, 等. Hem-o-lok结扎夹在腹腔镜肾部分切除术中的应用[J]. 临床泌尿外科杂志, 2008, 23(12):946-947.
[10]	Marberger M. Renal ischaemia:not a problem in laparoscopic partial nephrectomy[J]? BJU Int, 2007, 99(1):3-4.
[11]	Porpiglia F, Renard J, Billia M, et al. Is renal warm ischemia over 30 minutes during laparoscopic partial nephrectomy possible? One-year results of a prospective study[J]. Eur Urol, 2007, 52(4):1170-1178.
[12]	Shekarriz B, Shah G, Upadhyay J. Impact of temporary hilar clamping during laparoscopic partial nephrectomy on postoperative renal function:a prospective study[J]. J Urol, 2004, 172(1):54-57.
[13]	Shao P, Qin C, Yin C, et al. Laparoscopic patial nephrectomy with segmental renal artery clamping:technique and clinical outcomes[J]. Eur Urol, 2011, 59(5):849-855.
[14]	Landman J, Rehman J, Sundaram C P, et al. Renal hypothermia achieved by retrograde intracavitary saline perfusion[J]. J Endourol, 2002, 16(7):445-449.