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目的:探讨后腹腔镜下肾部分切除术在肾脏肿瘤测量评分系统(R.E.N.A.L.评分)为中度复杂性肾癌中的应用。方法:回顾性分析2005年4月～2011年6月82例R.E.N.A.L.评分为中度复杂性(7～9分)肾肿瘤患者的临床资料,其中男51例,女31例,平均年龄(53.2±9.8)岁。肿瘤平均直径(3.0±0.9)cm,其中左侧36例,右侧46例;背侧48例,腹侧34例;肿瘤靠近肾门血管11例,82例患者均行后腹腔镜肾部分切除术。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(102.0±23.1)min,术中平均热缺血时间(17.3±4.6)min,术中平均出血量(26.8±7.9)ml,术后平均住院时间(5.0±1.2)d,术后尿漏3例,留置导尿及输尿管导管后1周症状消失;术后肌酐短暂升高8例,均在6周内降至正常范围;术后平均随访(33.5±11.6)个月,80例患者术后6个月预估肾小球率过滤(eGFR)较术前无统计学意义,另2例患者eGFR分别下降30%、35%;术后肾功能长期维持在CKD3期和CDK2期分别为2例和3例,均未行血液透析治疗,余患者未发生肾功能不全;所有患者随访期间未见肿瘤复发及转移。结论:后腹腔镜肾部分切除术治疗R.E.N.A.L.评分为中度复杂性肾癌安全、有效,但其远期疗效尚需大样本对照研究和长期随访观察。
Objective: To investigate the application of retroperitoneal partial nephrectomy in the moderate renal neoplasm with renal tumor scoring system (R.E.N.A.L. score). Methods: From April 2005 to June 2011, 82 patients with RENAL score of 7 to 9 years old with moderate renal tumor were retrospectively analyzed. There were 51 males and 31 females with a mean age of 53.2 ± 9.8) years old. The mean tumor diameter was (3.0 ± 0.9) cm, including 36 on the left and 46 on the right, 48 on the dorsal side and 34 on the ventral side. The tumors were adjacent to the renal portal vessels in 11 and 82 on the laparoscopic partial nephrectomy Surgery. Results: All the operations were successfully completed, no transfer to open, no serious perioperative complications. The mean operative time was (102.0 ± 23.1) min, the average time of intraoperative warm ischemia was (17.3 ± 4.6) min, the mean intraoperative blood loss was (26.8 ± 7.9) ml, the average postoperative hospital stay was 5.0 ± 1.2 days, Urine leakage in 3 cases, indwelling catheter and ureteral catheter disappeared 1 week after symptoms; postoperative creatinine transient increase in 8 cases, were within 6 weeks to the normal range; average follow-up (33.5 ± 11.6) months, 80 cases The estimated glomerular filtration rate (eGFR) at 6 months postoperatively was not statistically different from preoperative, and the other 2 patients’ eGFR decreased by 30% and 35% respectively. The postoperative renal function was maintained at CKD stage 3 and CDK2 stage 2 cases and 3 cases were not hemodialysis treatment, the remaining patients did not occur renal insufficiency; no recurrence and metastasis of all patients during the follow-up. Conclusions: Retroperitoneal nephrectomy for the treatment of moderately complex renal cell carcinoma with R.E.N.A.L. score is safe and effective, but its long-term curative effect still needs large sample controlled study and long-term follow-up observation.