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目的:评价后腹腔镜肾部分切除术(RLPN)治疗≥7cm肾肿瘤的可行性。方法:回顾性分析2008年6月~2012年3月行RLPN的28例肾肿瘤患者资料。28例平均体质指数23.6kg/m2,麻醉评分1~2分,术前影像学检查未发现有其他邻近脏器浸润、淋巴结转移或远处转移。结果:本组28例手术均获得成功。平均手术时间115min;平均出血量50ml;平均热缺血时间23min。平均术后卧床时间5.5d;平均术后引流管留置时间5d;平均术后引流量195ml;平均术后住院8d。术后病理示肿瘤直径7~16cm,平均8cm。血管平滑肌脂肪瘤25例,脂肪瘤1例,Ⅰ型乳头状肾细胞癌1例,多房囊性肾细胞癌1例。术后随访7~52个月,平均34.5个月,所有患者肾功能正常且未见肿瘤复发及转移。结论:对于≥7cm的肾肿瘤,RLPN在技术层面是可行和安全的,但必须谨慎选择病例。目前还需要长期的、大量的临床资料对这一术式进行全面的评估。
Objective: To evaluate the feasibility of retroperitoneal laparoscopic partial nephrectomy (RLPN) for the treatment of ≥7 cm renal tumors. Methods: The data of 28 patients with renal tumors who underwent RLPN from June 2008 to March 2012 were retrospectively analyzed. 28 patients with an average body mass index of 23.6kg / m2, anesthesia score of 1 to 2, preoperative imaging examination found no other adjacent organ infiltration, lymph node metastasis or distant metastasis. Results: All the 28 cases in this group were successful. The average operation time was 115min. The mean amount of bleeding was 50ml. The average time of warm ischemia was 23min. The average postoperative bed time 5.5d; the average postoperative drainage tube indwelling time 5d; the average postoperative drainage 195ml; average postoperative hospitalization 8d. Postoperative pathology showed tumor diameter 7 ~ 16cm, an average of 8cm. 25 cases of angiomyolipoma, 1 case of lipoma, 1 case of type I papillary renal cell carcinoma and 1 case of multilocular renal cell carcinoma. All cases were followed up for 7 to 52 months with an average of 34.5 months. All patients had normal renal function and no tumor recurrence and metastasis. CONCLUSIONS: RLPN is technically feasible and safe for ≥7 cm renal tumors, but care must be taken in the selection of cases. There is still a need for a long-term, extensive clinical data to conduct a comprehensive assessment of this procedure.