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目的探讨不阻断肾动脉的零缺血腹腔镜肾血管平滑肌脂肪瘤(renal angiomyolipoma,RAML)剜除术的可行性及有效性。方法 2013年12月~2015年6月,行14例不阻断肾动脉的腹腔镜下RAML切除术,2例为孤立肾。右侧8例,左侧6例。单发11例,多发3例。肿瘤直径3.5~8 cm,平均4.5 cm。肿瘤位于肾脏上极5例,下极6例,肾窦内3例。10例经后腹腔途径,4例经腹腔途径。术中先游离肾动脉以备阻断。充分暴露肿瘤后,于肿瘤边缘标记切除范围,超声刀沿肿瘤边缘边切边用吸引器吸引,逐步切除肿瘤,用吸引器彻底吸除基底部残留肿瘤组织。小的肿瘤创面用V-Loc免打结缝线全层缝合,大的创面先缝合基底部止血并缩小创面,再缝合创面;肾窦内小的肿瘤切除后用止血材料填塞。结果 14例手术均成功,均未阻断肾动脉,无中转开放手术。手术时间54~87 min,平均67 min。术中出血30~350 ml,平均130 ml。术后无继发出血、漏尿及急性肾功能衰竭等并发症。随访5~12个月,平均8.3月,未见肿瘤残留及复发。结论不阻断肾动脉的状态下可以完成腹腔镜RAML剜除术。术前应完善影像学检查,了解肿瘤与肾脏血管的位置关系,术中要游离肾动脉做好阻断准备工作。
Objective To investigate the feasibility and effectiveness of zero laparoscopic renal angiomyolipoma (RAML) resection without renal artery occlusion. Methods From December 2013 to June 2015, 14 patients underwent laparoscopic RAML resection without renal artery occlusion and 2 as isolated kidney. Right in 8 cases, left in 6 cases. Single in 11 cases, multiple in 3 cases. Tumor diameter 3.5 ~ 8 cm, an average of 4.5 cm. The tumors were located in the upper pole of the kidney in 5 cases, in the lower pole in 6 cases and in the renal sinus in 3 cases. Ten cases were treated by retroperitoneal approach and four cases were treated by intraperitoneal route. Intraoperative free renal artery ready for the block. After the tumor was fully exposed, the excision range was marked at the edge of the tumor. The edge of the tumor was trimmed with an aspirator to attract the tumor. The tumor was gradually removed and the residual tumor tissue was completely aspirated by the aspirator. The small tumor wound was completely stitched with a V-Loc knot stitch suture. The large wound was first stitched to the base to stop the bleeding and then the wound was closed. The small wound in the renal sinus was resected with a hemostatic material. Results All the 14 surgeries were successful. None of the patients had renal artery occlusion and no open surgery. The operative time ranged from 54 to 87 minutes with an average of 67 minutes. Intraoperative bleeding 30 ~ 350 ml, an average of 130 ml. No postoperative secondary bleeding, leakage of urine and acute renal failure and other complications. Follow-up 5 to 12 months, an average of 8.3 months, no tumor residual and recurrence. Conclusion Laparoscopic RAML can be performed without blocking the renal artery. Preoperative imaging studies should be improved to understand the tumor and the relationship between the location of renal blood vessels, surgery to free the renal artery to do a good job blocking preparations.