目的探讨不阻断或短时间阻断肾动脉行腹腔镜保留肾单位手术的临床效果。方法2004年9月~2006年11月,采用不阻断或短时间阻断肾动脉对29例肾肿瘤行腹腔镜保留肾单位手术。25例采用经后腹腔途径,4孔法操作,游离出肾动脉,血管束带绕过肾动脉后经套管引出体外,暂不阻断肾动脉,切除肿瘤表面及周围的肾脂肪囊,超声刀沿瘤体边缘外0.5 cm处分离,由浅入深,边切割边止血,直到完全切除肿瘤。若切除肿瘤过程中肾脏创面出血过多影响操作,可暂时阻断肾动脉并计时,迅速切除肿瘤,双极电凝止血后,即可开放肾动脉。止血纱布块填压肾脏创面,2-0可吸收线间断全层缝合肾实质创面,表面喷洒生物蛋白胶。4例采用经腹腔途径,肾下极找出输尿管,挑起后向肾门处游离,找出肾动脉,余步骤同腹膜外途径。结果29例均完成腹腔镜保留肾单位手术,术中20例未阻断肾动脉,9例阻断肾动脉,平均阻断时间14 min(5~20 min),平均手术时间165 min(105~240 min),平均出血量90 ml(20~800 ml),2例输血,无尿漏等其他并发症。术后住院时间平均9 d(7~17 d)。18例肾癌平均随访9个月(1~26个月),肿瘤无复发。结论不阻断或短时间阻断肾动脉行腹腔镜保留肾单位手术安全可靠,但应选择未侵及肾脏集尿系统的外周型肿瘤。 Objective To investigate the clinical effect of laparoscopic nephron surgery without blocking or short-term blocking of renal artery. Methods From September 2004 to November 2006, nephron units were retained by laparoscopy in 29 cases of renal tumors without blocking or short-term blocking of renal artery. Twenty-five cases were treated by retroperitoneal approach and 4-hole method. The renal artery was isolated from the renal artery. After the renal artery was passed around the renal artery, the renal artery was excised temporarily and the renal fat capsule was excised from the tumor surface. Knife along the edge of the tumor 0.5 cm away from the Department, from the shallow into the deep, while cutting the hemostasis, until the complete removal of the tumor. If the removal of tumor in the process of excessive bleeding of the kidney wound operation, can temporarily block the renal artery and timing, rapid removal of the tumor, bipolar coagulation hemostasis, you can open the renal artery. Hemostatic gauze pad fill the kidney wound, 2-0 absorbable line interrupted full-thickness suture renal parenchymal wound, spraying the surface of biological protein glue. In 4 cases, the transperitoneal approach was used. The ureter was found in the lower pole of the kidney and the renal artery was provoked and then the renal artery was found. The remaining steps were the same as the extraperitoneal route. Results All of the 29 patients underwent laparoscopic nephron surgery. Among them, 20 had no renal artery occlusion, 9 had renal artery occlusion, and the mean occlusion time was 14 min (5-20 min). The mean operation time was 165 min (105 ~ 240 min). The mean blood loss was 90 ml (20-800 ml). Two other complications such as blood transfusions and no urine leakage occurred. The average postoperative hospital stay was 9 days (ranged from 7 to 17 days). 18 cases of renal cell carcinoma were followed up for an average of 9 months (1 ~ 26 months), the tumor without recurrence. Conclusion It is safe and reliable to block renal artery by laparoscopic nephrectomy without blocking or short-term blocking of renal artery. However, peripheral neoplasms that do not invade renal urine collection system should be selected.