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目的探讨后腹腔镜辅助经腰小切口肾部分切除术治疗复杂性T1期肾癌的可行性及其疗效。方法回顾分析2010年7月至2013年12月间我科收治的28例复杂性T1期肾癌患者的临床资料,肿瘤直径(3.76±1.28)cm,其中内生性肾癌13例,T1b期肾癌12例,近肾门肾癌7例,解剖性孤立肾肾癌2例,肾肿瘤解剖学特征PADUA评分为(9.07±1.25)分。所有患者均接受后腹腔镜辅助经腰小切口肾部分切除术治疗。结果 28例患者均顺利完成手术,围手术期无尿漏、大出血等严重并发症,手术时间(213.82±40.04)min,术中肾脏冷缺血时间(23.88±5.98)min,手术出血量(191.07±94.33)mL,手术切口长度(9.48±1.56)cm,患者术后疼痛评分(1.11±0.31)分,2例患者术后出现短暂性高热,经对症处理后体温恢复正常。患者术后平均住院(11.54±3.98)d,均正常出院。术后随访(21.46±12.15)个月,术后第1个月患侧肾脏肾小球滤过率(GFR)平均下降(21.71±11.48)%,随访期间均未发现肿瘤局部复发或远处转移。结论后腹腔镜辅助经腰小切口肾部分切除术治疗体积较大、内生性生长或靠近肾门的复杂性T1期肾癌疗效满意,技术上安全、可行,便于实施和掌握,其手术切口创伤较小,值得临床推广应用,其远期疗效尚需大样本随机对照研究和长期随访观察。
Objective To investigate the feasibility and efficacy of retroperitoneal laparoscopic assisted minor partial nephrectomy in the treatment of complicated T1 stage renal cell carcinoma. Methods The clinical data of 28 patients with complicated T1 stage renal cell carcinoma treated in our department from July 2010 to December 2013 were retrospectively analyzed. The diameter of tumor (3.76 ± 1.28) cm, including 13 cases of endogenous renal cell carcinoma, T1b stage renal 12 cases of cancer, 7 cases of proximal renal cell carcinoma, 2 cases of anatomically isolated renal cell carcinoma and PADUA of 9.07 ± 1.25. All patients underwent laparoscopic assisted small incision partial nephrectomy. Results All the 28 patients were successfully performed the operation. There were no serious complications such as urinary leakage and hemorrhage in the perioperative period. The operative time (213.82 ± 40.04) min, the duration of cold ischemia in the kidney (23.88 ± 5.98) min, the operative bleeding ± 94.33) mL. The length of the surgical incision was 9.48 ± 1.56 cm. The postoperative pain score was 1.11 ± 0.31. Two patients experienced transient hyperthermia after operation. The body temperature returned to normal after symptomatic treatment. The average postoperative hospital stay (11.54 ± 3.98) d, were normal discharge. The average follow-up time was (21.46 ± 12.15) months after operation. The mean glomerular filtration rate (GFR) of the ipsilateral kidney decreased by 21.71 ± 11.48% at the first month after operation. No local recurrence or distant metastasis was found during follow-up . Conclusions Retroperitoneal laparoscopic partial small incision partial nephrectomy for the treatment of complex T1 stage renal carcinoma with large volume, endogenous growth or close to the renal portal is effective, safe, feasible and easy to implement and master. The surgical incision trauma Smaller, worthy of clinical promotion and application, its long-term curative effect still needs large sample randomized controlled study and long-term follow-up observation.