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目的:探讨在腹腔镜超声引导下完全内生型和肾门旁肾肿瘤行肾部分切除术的安全性和可行性。方法:回顾性分析2015年5月~2016年5月期间行此类手术共20例患者的临床资料。手术过程中游离肾动脉,显露患肾后用腹腔镜超声定位肿瘤。根据超声影像用电刀在肾包膜上标记切缘。阻断患肾动脉后,注入冰水混合物降低肾脏表面温度,完整切除肿瘤后缝合创缘。结果:18例手术成功,1例改根治性肾切除术,1例考虑副肾动脉损伤中转开放肾部分切除术。平均手术时间134.6 min(90~240min)。后腹腔途径(共18例)热缺血时间(WIT)为25.3min(18~38min),2例经腹腔途径WIT分别为29和19min。平均出血量123.3ml(20~300ml)。平均术后住院时间8.5d(6~10d)。术后2例患者出现血尿,分别于术后第3天和第5天自行消失。无迟发出血及漏尿。病理诊断10例透明细胞性肾细胞癌,5例乳头状肾细胞癌,4例血管平滑肌脂肪瘤,1例后肾腺瘤。术前患肾平均GFR为48.6ml·min-1·1.73m-2(33.8~61.0ml·min-1·1.73m-2),术后3个月复查GFR为41.1 ml·min-1·1.73 m-2(28.6~51.7ml·min-1·1.73m-2)。随访3~12个月,无肿瘤复发及转移。结论:腹腔镜超声引导下腹腔镜肾部分切除术治疗完全内生型和肾门旁肾肿瘤是安全可行。使用术中超声有助于肿瘤精确定位,减少肾血管损伤,最大限度保留肾功能。
Objective: To investigate the safety and feasibility of partial nephrectomy in complete endogenous and perinephric nephrectomy guided by laparoscopic ultrasound. Methods: The clinical data of 20 patients who underwent such surgery between May 2015 and May 2016 were retrospectively analyzed. Free renal artery during surgery, revealed by renal laparoscopic ultrasound positioning of the tumor. According to the ultrasound image with a knife on the renal capsule labeled margin. After blocking the renal artery, the ice water mixture is injected to reduce the surface temperature of the kidney, and a complete resection of the tumor is achieved after the tumor is sutured. RESULTS: Eighteen patients were successfully operated, one patient underwent radical nephrectomy, and one patient underwent partial nephrectomy considering renal artery injury. The average operation time was 134.6 minutes (90 ~ 240 minutes). The WIT was 25.3 minutes (18-38 minutes) in the retroperitoneal approach (18 cases in total), and the WIT was 29 and 19 minutes in 2 cases. The average amount of bleeding 123.3ml (20 ~ 300ml). The average postoperative hospital stay 8.5d (6 ~ 10d). Two patients had hematuria after operation, disappearing on the 3rd and 5th day respectively. No delayed bleeding and leakage of urine. Pathological diagnosis of 10 cases of clear cell renal cell carcinoma, 5 cases of papillary renal cell carcinoma, 4 cases of angiomyolipoma, 1 case of renal adenoma. Preoperative renal GFR was 48.6ml · min-1 · 1.73m-2 (33.8 ~ 61.0ml · min-1 · 1.73m-2), and the GFR was 41.1 ml · min-1 · 1.73 at 3 months after operation m-2 (28.6 to 51.7 ml · min -1 · 1.73 m -2). Follow-up 3 to 12 months, no tumor recurrence and metastasis. CONCLUSION: Laparoscopic ultrasound-guided laparoscopic partial nephrectomy is safe and feasible for the treatment of completely endogenous and perinephric nephrotic tumors. The use of intraoperative ultrasound helps to accurately locate the tumor, reduce renal vascular damage, maximize the retention of renal function.