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目的:探讨后腹腔镜保留肾单位手术(LNSS)术式对术肾肾功能的影响。方法:2009年1月-2010年12月行经后腹膜途径腹腔镜保留肾单位手术例26。男16例,女10例。随访时间>1年的有18例。年龄40-70岁。肾细胞癌23例,肾嫌色细胞癌2例,肾平滑肌瘤1例。肿瘤直径2.6-3.2cm,平均2.9cm。所有患者术中阻断肾动脉,剪刀切除肿瘤。术中肾动脉阻断时间20-30min,平均26.4分钟。分别于术前、术后2周、术后3月、术后1年测定双肾显像、血清肌酐、血清胱抑素。结果:18例患者术肾术前GFR及占总GFR的比例分别为53.2±7.8 ml/min和50.7±3.6%,术后两周GFR及占总GFR的比例分别为31.2±8.9 ml/min和35.8±5.8%,术后3月GFR及占总GFR的比例分别为34.7±8.6 ml/min和38.4±5.3%,术后1年GFR及占总GFR的比例分别为41.1±9.7 ml/min和43.2±6.2%。血清肌酐及血清胱抑素术前术后对比因为受对侧肾功能的影响不能反映对分肾功能的影响。结论:LNSS术式对于直径小于4cm的肾早期肿瘤是切实可行的。
Objective: To investigate the effect of retroperitoneal laparoscopic nephron surgery (LNSS) on renal function and renal function. METHODS: Laparoscopic nephron surgery was performed through the retroperitoneal approach from January 2009 to December 2010,26. 16 males and 10 females. Follow-up time> 1 year in 18 cases. Age 40-70 years old. 23 cases of renal cell carcinoma, 2 cases of chromophobe renal cell carcinoma and 1 case of renal leiomyoma. Tumor diameter 2.6-3.2cm, an average of 2.9cm. All patients were blocked intraoperative renal artery, scissors to remove the tumor. Intraoperative renal artery blocking time 20-30min, an average of 26.4 minutes. Renal imaging, serum creatinine and serum cystatin were measured before operation, 2 weeks after operation, 3 months after operation and 1 year after operation respectively. Results: The preoperative GFR and total GFR in 18 patients were 53.2 ± 7.8 ml / min and 50.7 ± 3.6%, respectively. The GFR and total GFR in two weeks after operation were 31.2 ± 8.9 ml / min and 35.8 ± 5.8%. The ratios of GFR and total GFR were 34.7 ± 8.6 ml / min and 38.4 ± 5.3% respectively at 3 months and 41.1 ± 9.7 ml / min respectively at 1 year after operation 43.2 ± 6.2%. Serum creatinine and serum cystatin compared before and after surgery due to contralateral renal function can not reflect the impact on renal function. Conclusion: The LNSS procedure is feasible for early neoplasms of kidney less than 4 cm in diameter.