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目的:探讨腹腔镜肾部分切除术治疗完全肾内型肾肿瘤的手术技巧及结果。方法:2008年9月~2013年8月采用腹腔镜下肾部分切除术治疗完全型肾肿瘤患者5例,其中肾透明细胞癌4例,肾错构瘤1例;经腹膜后腔途径4例,经腹腔途径1例。手术的关键步骤包括术中超声的应用、肾蒂的阻断和肾脏集合系统的缝合等。结果:5例患者手术均顺利完成,平均手术时间180(135~250)min,肾蒂阻断时间22~40min,平均33min。肿瘤大小平均2.3(1.5~3.0)cm,术中平均出血量180(100~250)ml,均未输血,术中需集合系统修补4例。术后随访5~55个月,平均35.3个月,均未见肿瘤局部复发或远处转移。结论:腹腔镜肾部分切除术治疗完全肾内型肾肿瘤安全有效,术中超声检查可对肿瘤进行有效定位,减少切缘的阳性率,是手术成功的关键。
Objective: To explore the surgical techniques and results of laparoscopic partial nephrectomy for the treatment of complete nephrotic nephroma. Methods: From September 2008 to August 2013, 5 cases of complete renal neoplasm were treated by laparoscopic partial nephrectomy, including 4 cases of clear cell renal cell carcinoma and 1 case of renal hamartoma. Four cases of retroperitoneal approach , 1 case of intraperitoneal route. The key steps of surgery include the application of intraoperative ultrasound, the block of renal pedicle and the suture of the renal collecting system. Results: All the 5 patients were successfully performed. The average operation time was 180 (135 ~ 250) min and the renal pedicle block time was 22 ~ 40 min (average, 33 min). The mean tumor size was 2.3 (1.5-3.0) cm. The mean intraoperative blood loss was 180 (100-250) ml. No blood transfusion was required. Four patients needed to be treated with an integrated system during operation. The patients were followed up for 5 to 55 months with an average of 35.3 months. No local tumor recurrence or distant metastasis was found. Conclusions: Laparoscopic partial nephrectomy is safe and effective for the treatment of complete nephrotic renal neoplasms. Intraoperative ultrasonography can effectively locate the tumor and reduce the positive rate of the margins, which is the key to successful operation.