Retroperitoneal laparoscopic nephron-sparing surgery for renal angiomyolipoma（report of 20cases）
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摘要: 目的:探讨后腹腔镜保留肾单位手术治疗肾错构瘤的手术技巧和临床效果。方法:采用后腹腔镜技术对20例肾错构瘤患者行肿瘤剜除术。其中择期手术患者19例,因肾错构瘤破裂出血急诊手术1例。肿瘤直径1.8~8.7 cm,平均4.8 cm。采用单纯肾动脉阻断并以吸引器吸除肿瘤的手术方法,观察手术时间、术中出血量、术后住院天数和术中术后并发症及手术效果。结果:20例手术均获得成功,无中转开放手术。平均手术时间119 min,19例择期手术患者平均出血量85 ml,急诊患者未行肾动脉阻断,术中出血约为1 000 ml。平均术后住院时间9.9 d。1例术后出现尿瘘,经保守治疗愈合出院。其他患者无围手术期并发症。术后随访3~60个月,无肿瘤复发。结论:后腹腔镜肾错构瘤剜除术应用肾动脉热缺血阻断、介入超声、吸引器吸除肿瘤、术前放置输尿管导管、止血手段等新技术安全可行,具有创伤小、并发症少、恢复快、住院时间短等优点。Abstract: Objective:To evaluate the surgical techniques and clinical effiicacy of retroperitioneal laparoscopic nephron-sparing surgery for renal angiomyolipoma.Method:Twenty patients with renal angiomyolipoma underwent enucleation through retroperitioneal laparoscopic surgery.19 were selective and 1 was emergency. Mean tumor size was 4.8 cm (range from 1.8 to 8.7 cm).The surgical techniques involved preoperative ureteral catheterization, transient atraumatic occluding of the renal artery and intraoperative laparoscopic ultrasonography.The resection and hemostasis were achieved mainly by LigaSure,Harmonic Scalpel and Aspirator.The operative time,blood loss,perioperative complications and operative effect were evaluated.Result:All the procedures were successful without conversion to open surgery in all patients.The mean operative time was 119 minutes and mean blood loss was 85 ml in 19 selective operation patients.Without occluding of the renal artery,the blood loss of emergency was 1 000 ml.One case suffered urinary fistula postoperatively and recovered by conservative treatment.Pathological examination confirmed renal angiomyolipoma in all 20 patients.No tumor recurrence was found during a follow-up of 3-60 months.Conclusion:The new surgical techniques of retroperitoneal laparoscopic partial nephrectomy is feasible and safe for renal angiomyolipoma.This procedure has the advantages of precise and complete tumor excision,minimal invasion,less complications and shorter convalescence.
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Key words:
- laparoscopy /
- nephron-sparing surgery /
- renal angiomyolipoma
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