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目的介绍腹腔镜下钳夹法肾蒂阻断、锐性切除肿瘤以及创面直接缝合行保留肾单位的肾肿瘤切除术方法及手术技巧。方法2003年6月至2005年6月,收治肾外生性实性肿瘤患者16例。男5例,女11例。年龄29~56岁,平均46岁。肿瘤位于左侧9例,右侧7例。肾细胞癌5例,肿瘤直径2.0~3.5cm;肾错构瘤11例,肿瘤直径3.0~5.5cm,其中1例肾错构瘤继发出血。经腹腔路径行保留肾单位的腹腔镜肾肿瘤切除术,手术在无损伤钳钳夹肾蒂控制血管后距肿瘤0.5~1.0cm正常实质处锐性切除,创面缝合止血。结果16例手术均成功。手术时间70~150min,平均104min。肾蒂阻断时间14~32min,平均21min。术中出血量50~700ml,平均158ml。5例肾细胞癌患者病理检查示切缘阴性。16例术后无尿瘘、无继发出血,肾功能未见异常。2~4d肛门排气,平卧1周出院。随访1~24个月,16例B超复查、11例CT检查肿瘤无复发,IVU复查肾显影良好。结论可靠的肾血管控制是腹腔镜下行保留肾单位的肾肿瘤切除术的基本保证,无烟雾锐性切除肿瘤和创面的缝合处理能有效减少肾缺血时间,是保留、保护肾单位的有效手段,也是最有效的止血方法。本手术创伤小、出血少、痛苦少、并发症少、恢复快,能有效切除肿瘤和保留或保护肾功能。
Objective To introduce laparoscopic nephroureterectomy and sharp neoplasm resection and direct suture of the wound to retain nephron nephrectomy methods and surgical techniques. Methods From June 2003 to June 2005, 16 patients with nephrogenic solid tumors were treated. 5 males and 11 females. Age 29 to 56 years old, average 46 years old. The tumor was located on the left side in 9 cases and on the right side in 7 cases. 5 cases of renal cell carcinoma, tumor diameter 2.0 ~ 3.5cm; renal hamartoma 11 cases, tumor diameter 3.0 ~ 5.5cm, of which 1 case of renal hamartoma secondary hemorrhage. Laparoscopic renal nephrectomy with nephron preserved by the celiac path was performed. The surgical resection was performed at the site of 0.5-1.0 cm from the tumor without any injury to the renal pedicle. The wounds were sutured to stop the bleeding. Results 16 cases were successful. Surgery time 70 ~ 150min, an average of 104min. Kidney pedicle block time 14 ~ 32min, an average of 21min. Intraoperative bleeding 50 ~ 700ml, an average of 158ml. Pathological examination of 5 cases of renal cell carcinoma showed negative margins. There were no urinary fistulas in 16 cases, no secondary hemorrhage and no abnormal renal function. 2 ~ 4d anal exhaust, supine 1 week discharged. Follow-up 1 to 24 months, 16 cases of B-ultrasound, 11 cases of CT without tumor recurrence, IVU review of renal development was good. Conclusions Reliable renal vascular control is the basic guarantee of laparoscopic nephron nephrectomy for nephron preservation. Sutureless treatment of neoplasm without tumor and smoke can effectively reduce the time of renal ischemia, which is an effective means of preserving and protecting nephron , Is also the most effective hemostatic method. The surgical trauma, less bleeding, less pain, fewer complications, faster recovery, can effectively remove the tumor and retain or protect renal function.