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目的:探索分析临床上经腹入路腹腔镜下肾部分切除术(LPN)治疗R.E.N.A.L.评分≥7的肾肿瘤的安全性和可行性,评价手术疗效,探讨临床应用价值。方法:收集2011年1月~2014年3月R.E.N.A.L.评分≥7的肾肿瘤患者行经腹入路LPN共38例,其中男20例,女18例,年龄(58.5±12.1)岁,体重指数(25.2±2.4)kg/m2,ASA评分(1.8±0.5)分,Charlson并发症指数(3.6±1.2),肿瘤左侧17例,右侧21例,肿瘤最大径(4.2±1.7)cm,肾肿瘤R.E.N.A.L.评分(8.6±1.2)。所有患者均行经腹入路LPN。观察和记录手术相关参数、术后情况,评价手术疗效,记录并发症,所有患者常规随访。结果:1例患者转为开放手术,其余患者手术均顺利完成,手术时间(240.2±57.2)min,术中估计出血(282.8±132.4)ml,术中输血率为7.9%(3/38),肾脏热缺血时间(23.2±8.6)min,手术切缘均为阴性。术后住院时间(8.9±3.2)d,术后1例发生漏尿,予以留置双J管,无其他并发症。病理检查为肾透明细胞癌20例,乳头状癌5例,嫌色细胞腺癌3例,肾错构瘤10例。术后随访(72.5±8.8)个月,2例患者因心血管疾病死亡,其余患者均存活,无患者出现局部肿瘤复发或远处转移。结论:对R.E.N.A.L.评分≥7的复杂性肾肿瘤,行经腹入路LPN是一种安全、有效的手术方式,具有操作空间大、易于暴露等优点,具有临床推广应用价值。
OBJECTIVE: To explore the safety and feasibility of transabdominal laparoscopic partial nephrectomy (LPN) in the treatment of renal tumors with R.E.N.A.L. score ≥7, evaluate the curative effect and discuss the clinical value. Methods: From January 2011 to March 2014, 38 patients with renal tumors with RENAL ≥7 were randomly divided into LPN group (20 males and 18 females, mean age 58.5 ± 12.1 years, body mass index 25.2 ± 2.4) kg / m2, ASA score (1.8 ± 0.5), Charlson’s complication index (3.6 ± 1.2), 17 on the left side of the tumor, 21 on the right and 4.2 ± 1.7 on the right. Score (8.6 ± 1.2). All patients underwent transabdominal approach LPN. Observe and record the relevant parameters of the surgery, postoperative condition, evaluate the curative effect, record the complication, all patients were followed up routinely. Results: One patient turned to open surgery and the other patients were successfully performed. The operation time was (240.2 ± 57.2) min, the intraoperative bleeding was estimated to be 282.8 ± 132.4 ml, and the intraoperative blood transfusion rate was 7.9% (3/38) Kidney warm ischemia time (23.2 ± 8.6) min, surgical margin were negative. The postoperative hospital stay was (8.9 ± 3.2) days. One case of postoperative leakage of urine left indwelling double J tube without other complications. Pathological examination of renal clear cell carcinoma in 20 cases, 5 cases of papillary carcinoma, chromophobe adenocarcinoma in 3 cases, renal hamartoma in 10 cases. All patients were followed up for 72.5 ± 8.8 months. Two patients died of cardiovascular disease, and the remaining patients survived. No local tumor recurrence or distant metastasis occurred. CONCLUSIONS: LPN is a safe and effective surgical approach for the treatment of complex renal tumors with R.E.N.A.L. score ≥7. It has the advantages of large operating space and easy exposure, which has the clinical application value.