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目的探讨后腹腔镜保留肾单位的肾部分切除术治疗T1期肾肿瘤的手术方法及临床疗效。方法回顾性分析22例行后腹腔镜保留肾单位的肾部分切除术的T1期肾肿瘤患者的临床资料,其中男8例,女14例,平均年龄48岁。双侧肾肿瘤1例,单侧双瘤灶1例;左侧13例,右侧10例。肿瘤平均直径3cm。所有患者均行后腹腔镜保留肾单位的肾部分切除术。结果 22例手术均顺利完成。平均手术时间135min,平均肾动脉阻断时间29min,平均出血量55ml,平均住院时间10d。术中未见外科并发症,术后仅1例发生漏尿。术中切缘组织病理均阴性。24个瘤灶术后病理证实为肾透明细胞癌19例、多房囊性肾细胞癌2例、肾嗜酸细胞瘤2例、肾嫌色细胞腺癌1例。随访时间1～28个月,平均10个月,肿瘤无局部复发及远处转移。结论后腹腔镜保留肾单位的肾部分切除术治疗T1期肾肿瘤安全、可行,其远期疗效尚待长期随访。
Objective To investigate the surgical methods and clinical effects of retroperitoneal nephron-retained nephron in the treatment of stage T1 nephrectomy. Methods The clinical data of 22 patients with T1 stage renal neoplasm who underwent laparoscopic nephron nephrectomy were retrospectively analyzed. There were 8 males and 14 females, with an average age of 48 years. 1 case of bilateral renal tumor, 1 case of unilateral double tumor; 13 cases on the left and 10 cases on the right. The average tumor diameter of 3cm. All patients underwent laparoscopic nephron nephrectomy. Results 22 cases were successfully completed. The average operation time was 135min, the mean renal artery occlusion time was 29min, the mean amount of bleeding was 55ml, the average hospitalization time was 10d. Surgery without surgical complications, only 1 case of postoperative leakage of urine. Intraoperative margins of histopathology were negative. Twenty-four tumors were histologically confirmed to be renal clear cell carcinoma in 19, polycystic renal cell carcinoma in 2, renal oncocytoma in 2, and chromophobe renal cell carcinoma in 1 patient. Follow-up time of 1 to 28 months, an average of 10 months, no local tumor recurrence and distant metastasis. Conclusions Laparoscopic nephron nephron excision for the treatment of stage T1 renal cancer is safe and feasible, and its long-term follow-up remains to be seen.