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目的:探讨中央型肾肿瘤腹腔镜肾部分切除术的手术技巧及结果。方法 :2006年6月～2011年6月,我院对8例中央型肾肿瘤施行腹腔镜下肾部分切除术。术中通过仔细游离肾蒂血管,选择性阻断或结扎滋养肿瘤的三级血管,以减少正常肾单位的热缺血时间和术中的出血。结果:8例手术均顺利完成,手术时间为150～300min,平均220min,肾血管阻断时间22～45min,平均33min。肿瘤大小为2.0～6.0cm,平均为2.8cm。需集合系统修补6例(75%)。术中出血量100～400ml,平均为130ml,均未输血。病理报告:肾透明细胞癌6例(75%),肾血管平滑肌脂肪瘤2例,术中及术后切缘均阴性。术后随访3～46个月,平均22.3个月,未见肿瘤局部复发或远处转移。结论:腹腔镜肾部分切除术治疗中央型肾肿瘤安全有效,选择性阻断或结扎滋养肿瘤的肾动脉三级分支可以有效减少正常肾单位的热缺血时间和出血,有利于该术式的开展。
Objective: To explore the surgical techniques and results of laparoscopic partial nephrectomy for central renal tumors. Methods: From June 2006 to June 2011, 8 cases of central renal tumors underwent laparoscopic partial nephrectomy in our hospital. Surgery by carefully free renal pedicle blood vessels, selective blocking or ligation nourish the tumor of the three vessels to reduce the normal nephron warm ischemia and intraoperative bleeding. Results: All the 8 cases were successfully completed. The operation time ranged from 150 to 300 minutes with an average of 220 minutes. The mean duration of renal vascular occlusion was 22 to 45 minutes with an average of 33 minutes. Tumor size 2.0 ~ 6.0cm, an average of 2.8cm. Six patients (75%) need to be collected to repair the system. Intraoperative blood loss of 100 ~ 400ml, an average of 130ml, were not transfused. Pathological reports: 6 cases of clear cell renal cell carcinoma (75%), 2 cases of renal angiomyolipoma, intraoperative and postoperative margins were negative. The patients were followed up for 3 to 46 months with an average of 22.3 months. No local tumor recurrence or distant metastasis was found. Conclusions: Laparoscopic partial nephrectomy for the treatment of central renal tumors is safe and effective. The tertiary branches of the renal arteries that selectively block or ligation the tumor can effectively reduce the warm ischemia time and bleeding of the normal nephrons, Carry out.