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目的:探讨微波消融辅助腹腔镜下肾部分切除术(microwave ablation assisted laparoscopic partial nephrectomy,MWA-LPN)治疗肾错构瘤的可行性及临床疗效。方法:回顾性分析2013年5月—2016年5月收治的经MWA-LPN治疗的49例直径>4 cm肾错构瘤患者的临床资料。男23例,女26例。年龄26~78岁,平均52.4岁。肿瘤最大直径5.0~13.0 cm,平均8.2 cm。术前患肾平均肾小球滤过率(glomerular filtration rate,GFR)为(43±16)m L/(min·1.73 m2)。所有患者都采用经后腹腔途径,应用KY-2000可控温杆微波消融仪,输出功率为80 W,每个周期消融时间1~3 min,共消融2~4个周期。消融结束后,沿肿瘤边缘锐性切除肿瘤。观察手术时间、术中出血量、术后并发症、术后住院时间及近期局部疗效。结果:49例手术顺利,无中转开放手术。平均手术时间(105.5±10.2)min,平均出血量(103.6±40.2)m L,1例患者术中输血,无术后出血病例。术后尿瘘2例。围手术期并发症发生率为6.1%。术后平均住院天数为(3.7±0.8)d。术后随访9~46个月,平均23.5个月。术后1个月复查GFR,平均(40±18)m L/(min·1.73 m2),与术前相比差异无统计学意义(P>0.05)。术后1个月和6个月复查CT,均未发现局部复发。结论:MWA-LPN治疗大于4 cm肾错构瘤安全有效,可以作为肾错构瘤的治疗方式之一,但远期效果尚需进一步随访观察。
Objective: To investigate the feasibility and clinical efficacy of microwave ablation assisted laparoscopic partial nephrectomy (MWA-LPN) in the treatment of renal hamartoma. Methods: The clinical data of 49 patients with diameter> 4 cm renal hamartoma treated by MWA-LPN from May 2013 to May 2016 were retrospectively analyzed. 23 males and 26 females. Age 26 to 78 years old, average 52.4 years old. The maximum tumor diameter 5.0 ~ 13.0 cm, an average of 8.2 cm. Preoperative renal glomerular filtration rate (GFR) was (43 ± 16) m L / (min · 1.73 m2). All patients were treated by the retroperitoneal approach. The KY-2000 temperature controlled microwave ablation instrument was used. The output power was 80 W, and the ablation time was 1 to 3 minutes per cycle. The ablation was performed for 2 to 4 cycles. After ablation, the tumor was sharply resected along the tumor margin. Observation of operation time, intraoperative blood loss, postoperative complications, postoperative hospital stay and recent local efficacy. Results: The operation of 49 cases was successful and there was no transit surgery. The mean operation time was (105.5 ± 10.2) min and the mean amount of bleeding was (103.6 ± 40.2) m L. One patient had intraoperative blood transfusion and no postoperative bleeding. Postoperative urinary fistula in 2 cases. The incidence of perioperative complications was 6.1%. The average postoperative hospital stay was (3.7 ± 0.8) d. The patients were followed up for 9 to 46 months with an average of 23.5 months. The GFR at 1 month after operation was averagely (40 ± 18) m L / (min · 1.73 m2), showing no significant difference compared with that before operation (P> 0.05). One month and six months after the review of CT, no local recurrence was found. CONCLUSIONS: MWA-LPN is safe and effective for the treatment of renal hamartomas larger than 4 cm. It can be used as a treatment for renal hamartoma, but the long-term effect needs further follow-up observation.