论文部分内容阅读
目的:介绍本中心肾部分切除术治疗内生性肾肿瘤的经验。方法:回顾性分析2009年7月~2014年7月在我院因内生性肾肿瘤手术治疗的23例患者资料,所有病例术前影像学检查都明确诊断为内生性肿瘤,内生性肿瘤定义为被正常肾实质完全包绕。患者年龄34~83岁,平均53.2岁;男11例,女12例。左侧病变9例,右侧病变14例,其中孤立肾1例。体质指数(BMI)19.1~27.7kg/m2,平均23.7kg/m2。术前肾小球滤过率(eGFR)40.3~158.6ml/min,平均92.4 ml/min。肿瘤直径为1.0~4.7cm,平均2.2cm。术前中山评分(ZS score)结果:低度复杂4例,中高度复杂19例。美国麻醉医师协会(ASA)分级标准:Ⅰ级13例,Ⅱ级9例,Ⅲ级1例。手术方式:小切口开放肾部分切除术(MI-OPN)20例,腹腔镜肾部分切除(LPN)1例,机器人辅助腹腔镜下肾部分切除(RALPN)2例。其中肾动脉阻断11例,未阻断12例。结果:23例手术顺利。手术时间为60~210min,平均103.7min。肾动脉阻断时间9~37min,平均22.8min。术中出血量50~1 000ml,平均233.5ml。术后住院时间4~14d,平均7.7d。术后并发症3例,迟发性出血2例,尿漏1例。所有手术切缘阴性,术后病理:透明细胞癌11例,乳头状肾癌3例,错构瘤6例,囊性病变1例,炎性肾瘤1例,肺癌肾转移1例。术后复查eGFR 35.5~124.5ml/min,平均76.3ml/min。随访6~48个月,平均16.5个月。15例恶性肿瘤患者中12例获得随访,均无瘤生存。结论:肾部分切除术可作为治疗内生性肾肿瘤的一个有效手段,但术中操作仍需谨慎,尽量减少围手术期严重并发症。
Objective: To introduce the experience of partial nephrectomy in the treatment of endogenous renal tumors in our center. Methods: The data of 23 patients with endogenous renal tumor surgically treated in our hospital from July 2009 to July 2014 were retrospectively analyzed. The preoperative imaging examination of all cases was clearly diagnosed as endogenous tumors. The endogenous tumors were defined as Is completely surrounded by normal renal parenchyma. Patients aged 34 to 83 years, mean 53.2 years; 11 males and 12 females. The left lesion in 9 cases, the right lesion in 14 cases, of which 1 case of isolated kidney. Body mass index (BMI) 19.1 ~ 27.7kg / m2, an average of 23.7kg / m2. Preoperative glomerular filtration rate (eGFR) 40.3 ~ 158.6ml / min, an average of 92.4 ml / min. Tumor diameter 1.0 ~ 4.7cm, an average of 2.2cm. Preoperative Zhongshan score (ZS score) results: 4 cases of low complexity, 19 cases of medium and high complexity. American Society of Anesthesiologists (ASA) grading standards: Ⅰ grade in 13 cases, Ⅱ grade in 9 cases, Ⅲ grade in 1 case. Surgical methods: 20 cases of small incision open partial nephrectomy (MI-OPN), 1 case of laparoscopic partial nephrectomy (LPN) and 2 cases of robotic laparoscopic partial nephrectomy (RALPN). Among them, 11 cases were blocked by renal artery and 12 cases were not blocked. Results: 23 cases were successful. Surgery time was 60 ~ 210min, an average of 103.7min. Renal artery blocking time 9 ~ 37min, an average of 22.8min. Intraoperative bleeding 50 ~ 1 000ml, an average of 233.5ml. Postoperative hospital stay 4 ~ 14d, an average of 7.7d. Postoperative complications in 3 cases, delayed bleeding in 2 cases, urinary leakage in 1 case. All surgical margins negative, postoperative pathology: clear cell carcinoma in 11 cases, papillary renal carcinoma in 3 cases, hamartoma in 6 cases, cystic lesions in 1 case, 1 case of inflammatory renal cell carcinoma, 1 case of lung cancer kidney metastases. Postoperative eGFR 35.5 ~ 124.5ml / min review, an average of 76.3ml / min. Follow-up 6 to 48 months, an average of 16.5 months. Twelve of the 15 patients with malignant tumors were followed up and had no tumor-free survival. Conclusion: Partial nephrectomy can be used as an effective method for the treatment of endogenous renal tumors. However, caution should be exercised during operation to minimize the serious complications during perioperative period.