论文部分内容阅读
目的探讨后腹腔镜保留肾单位手术(NSS)在治疗局限性肾癌中的临床应用。方法 2009年1月～2010年1月我院对15例局限性肾肿瘤行后腹腔镜NSS。选择临床分期T1a,单发且肿瘤直径2.2～4.3cm(平均3.4cm)的局限性肾肿瘤,术前逆行肾盂插管持续灌注4℃生理盐水实现低温保护,采用血管束带阻断肾动脉,剪刀距肿瘤5～10 mm将肿瘤完整切除,可吸收缝线缝合及止血纱布压迫止血,2-0可吸收线做8字缝合肾实质,以Hem-O-lok间断结扎代替打结。结果手术成功13例,1例术中因出血明显中转开放,1例术后继发性大出血二次行经腹残余肾切除。术后病理透明细胞癌13例,后肾腺瘤2例。手术时间100～180min,平均120min;平均热缺血时间28(21～35)min。术中出血量60～500ml(130ml);术后1例漏尿,留置双J管2周后自愈。平均住院时间7(6～14)d。术后随访15例,平均18(3～36)个月。患者术后肾功正常,肿瘤无复发及转移。结论后腹腔镜下NSS操作难度大,采用间隔Hem-o-lok结扎代替打结可以明显缩短手术时间和肾热缺血时间,降低操作难度,术前逆行肾盂插管解决了肾低温保护和术后漏尿2个问题,有利于延长肾缺血时间、保护肾功能,减少并发症。
Objective To investigate the clinical application of retroperitoneal laparoscopic nephron surgery (NSS) in the treatment of localized renal cell carcinoma. Methods From January 2009 to January 2010, 15 cases of renal failure were retrospectively performed laparoscopic NSS. Select the clinical stage T1a, single and tumor diameter of 2.2 ~ 4.3cm (average 3.4cm) of localized renal tumors, preoperative retrograde pyelonephritis continued perfusion of 4 ℃ saline for low temperature protection, the use of vascular fascia block renal artery, Scissors away from the tumor 5 ~ 10 mm tumor complete resection, suture suture can absorb and hemostatic gauze compression hemostasis, 2-0 absorbable line to do 8-suture renal parenchyma, intermittent ligation Hem-O-lok instead of knotted. Results The successful operation was performed in 13 cases. One case was obviously transferred to open operation due to hemorrhage during operation, and one case had secondary residual hemoinectomy secondary to postoperative secondary hemorrhage. Postoperative pathological clear cell carcinoma in 13 cases, 2 cases of adenocarcinoma of the kidney. The operation time was 100 ~ 180min with an average of 120min. The average time of warm ischemia was 28 (21 ~ 35) min. Intraoperative bleeding 60 ~ 500ml (130ml); 1 case of leakage of urine, indwelling double J tube self-healing after 2 weeks. The average length of stay 7 (6 ~ 14) d. Fifteen patients were followed up for an average of 18 (3-36) months. Patients with normal renal function, tumor recurrence and metastasis. Conclusions Retroperitoneal laparoscopic NSS is difficult to operate. Hem-o-lok ligation instead of knotting can significantly shorten the operation time and renal ischemia time and reduce the difficulty of operation. Preoperative retrograde pyelonephrosis solves the problem of renal hypothermia and surgery Leakage after 2 questions, is conducive to prolong renal ischemia, protect renal function and reduce complications.