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目的探讨非阻断肾动脉腹腔镜肾部分切除术治疗T1a期肾癌的临床经验与治疗效果。方法回顾性分析我单位2008年6月至2012年6月期间收治的93例T1a期肾癌患者的临床资料,其中男性61例,女32例,肿瘤直径[2.9±0.5(1.0～3.9)]cm,肿瘤位于左肾43例,右肾50例。所有患者均行非阻断肾动脉腹腔镜肾部分切除术。记录手术时间、术中出血量、术后住院时间、术中及术后并发症、术后肾功能及术后恢复情况。结果所有手术均顺利完成,无中转开放手术者,手术时间[93±16(70～140)]分钟。术中出血[110±28(20～280)]ml,均未输血。术后住院时间[9.5±2.0(7～15)]天。术后病理报告切缘均为阴性。术前尿素氮及肌酐的均值分别为(5.0±0.7)mmol/L、(68.4±15.3)μmol/L;术后1周复查血尿素氮及肌酐均值分别为(5.6±0.8)mmol/L、(73.7±11.6)μmol/L(P>0.05)。术中及术后无明显并发症。术后随访[37±4.5(12～60)]个月,患侧肾功能正常,肿瘤无复发及转移。结论非阻断肾动脉腹腔镜肾部分切除术治疗T1a肾肿瘤安全、有效,可将潜在的肾脏热缺血损伤降至最低。
Objective To investigate the clinical experience and therapeutic effect of non-blocking renal artery laparoscopic partial nephrectomy for stage T1a renal cell carcinoma. Methods The clinical data of 93 patients with stage T1a renal cell carcinoma admitted to our hospital from June 2008 to June 2012 were retrospectively analyzed. There were 61 males and 32 females with tumor diameter of 2.9 ± 0.5 (1.0-3.9) cm, tumor located in the left kidney 43 cases, 50 cases of right kidney. All patients underwent non-blocking renal artery laparoscopic partial nephrectomy. The operation time, intraoperative blood loss, postoperative hospital stay, intraoperative and postoperative complications, postoperative renal function and postoperative recovery were recorded. Results All the operations were successfully completed and no transit surgery was performed. The operation time was 93 ± 16 (70 ~ 140) minutes. Intraoperative bleeding [110 ± 28 (20 ~ 280]] ml, no blood transfusion. Postoperative hospital stay [9.5 ± 2.0 (7-15)] days. All the pathological results were negative. The average preoperative values of urea nitrogen and creatinine were (5.0 ± 0.7) mmol / L and (68.4 ± 15.3) μmol / L, respectively. The mean values of blood urea nitrogen and creatinine were (5.6 ± 0.8) mmol / (73.7 ± 11.6) μmol / L (P> 0.05). No intraoperative and postoperative complications. Follow up [37 ± 4.5 (12 ~ 60)] months, normal ipsilateral renal function, tumor recurrence and metastasis. Conclusion Non-blocking renal artery laparoscopic partial nephrectomy for the treatment of T1a renal tumors is safe and effective, and can minimize the potential renal ischemic injury.