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目的探讨腹腔镜下保留肾单位的肾部分切除术治疗肾肿瘤的临床疗效与手术经验。方法回顾分析2011年1月~2013年8月在该科室行保留肾单位的肾肿瘤切除术治疗的86例肾T1期肿瘤患者的临床资料,其中腹腔镜组:男28例,女25例;年龄38~73岁,平均(53.9±8.9)岁,肿瘤直径1.3~4.5 cm,平均(3.3±0.8)cm;开放手术组:男19例,女14例;年龄39~68岁,平均(54.7±6.1)岁,肿瘤直径1.4~4.4 cm,平均(3.3±0.6)cm。结果 86例手术均获得成功,腹腔镜组手术时间85~150 min,平均(105±10.9)min,术中出血量30~100 mL,平均(51.6±14.5)mL,肾脏热缺血时间17~32 min,平均(22.6±3.8)min,住院天数6~14 d,平均(9.1±1.9)d;开放手术组手术时间60~130 min,平均(92.0±19.9)min,术中出血量50~130 mL,平均(75.0±19.3)mL,肾脏热缺血时间20~38 min,平均(31.0±4.7)min,住院天数7~16 d,平均(11.0±2.7)d。86例患者均无术后并发症发生,术后随访未见复发。结论腹腔镜下保留肾单位手术治疗肾肿瘤手术创伤小,术后恢复快,疗效确切,安全有效。
Objective To investigate the clinical efficacy and surgical experience of partial nephrectomy for renal neoplasms with laparoscopic nephron preservation. Methods The clinical data of 86 patients with renal T1 tumor who underwent nephrectomy for nephron preservation in this department from January 2011 to August 2013 were retrospectively analyzed. The laparoscopic group included 28 males and 25 females. The average age was from 38 to 73 years, with an average of (53.9 ± 8.9) years and tumor diameter of 1.3 to 4.5 cm (mean, 3.3 ± 0.8 cm). In open surgery group, there were 19 males and 14 females with an average of 54.7 ± 6.1) years old. The diameter of tumor ranged from 1.4 cm to 4.4 cm, with an average of (3.3 ± 0.6) cm. Results All of the 86 operations were successful. The laparoscopic operation time was 85-150 min (mean, 105 ± 10.9) min, blood loss was 30-100 mL, mean (51.6 ± 14.5) mL, and renal warm ischemia was 17 ~ 32 (22.6 ± 3.8) min and hospital stay of 6-14 days (9.1 ± 1.9) days respectively. The operation time of open surgery group was 60-130 min (mean, 92.0 ± 19.9 min) 130 mL, mean (75.0 ± 19.3) mL, warm ischemic time of kidney ranging from 20 to 38 min (average, 31.0 ± 4.7) min and hospitalization days ranging from 7 to 16 days, with an average of (11.0 ± 2.7) days. None of the 86 patients had postoperative complications, and no recurrence was found after the operation. Conclusions Laparoscopic nephron nephron surgeries are safe and effective in the treatment of renal tumors with minimal trauma and postoperative recovery.