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目的:探讨后腹腔镜肾部分切除术治疗肾脏早期占位性病变的临床效果。方法:2004年6月～2011年1月对47例早期肾占位性病变患者行后腹腔镜肾部分切除术,其中恶性病变43例,可疑恶性病变4例。结果:47例手术均获得成功,无中转开放手术和后腹腔镜肾根治性切除术。平均手术时间(105±21.4)min(75～140 min),平均肾动脉阻断时间(24±6.5)min(17～40 min),平均出血量(160±74)ml(70～600 ml)。术后病理检查报告为透明细胞癌39例,其中1例术后病理检查结果证实切缘阳性;肾嫌色细胞癌2例;肾嗜酸细胞瘤2例;肾脏囊性病变4例。术后主要并发症为迟发性出血1例,尿瘘2例。随访1～78个月,平均(32±10.6)个月,均未见局部复发和远处转移。结论:对于腹腔镜技术熟练的操作者而言,后腹腔镜肾部分切除术可以作为治疗早期肾脏占位性病变的首选。手术过程中的一些焦点问题仍需要深入探讨。
Objective: To investigate the clinical effect of retroperitoneoscopic partial nephrectomy in the treatment of early space-occupying lesions in the kidney. Methods: From June 2004 to January 2011, 47 patients with early renal space-occupying lesions underwent laparoscopic partial nephrectomy, including 43 cases of malignant lesions and 4 of suspicious malignant lesions. Results: All the 47 surgeries were successful. There were no transfer and laparoscopic radical nephrectomy. The mean operative time (105 ± 21.4) min (75-140 min), mean renal artery occlusion (24 ± 6.5) min (17-40 min) and mean blood loss (160 ± 74) ml . Postoperative pathological examination was reported in 39 cases of clear cell carcinoma, of which 1 case confirmed positive margins after surgery; 2 cases of renal chromophobe carcinoma; 2 cases of renal oncocytoma; 4 cases of renal cystic lesions. The main complications were delayed bleeding in 1 case and 2 cases of urinary fistula. All the patients were followed up for 1 to 78 months, with an average of (32 ± 10.6) months. No local recurrence or distant metastasis was found. CONCLUSIONS: Retroperitoneoscopic partial nephrectomy can be the first choice for the treatment of early renal space-occupying lesions for a skilled operator of laparoscopy. Some of the focus of the surgery process still need to be explored in depth.