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目的评价经后腹腔镜联合经腰小切口及超声辅助下行中心型肾癌保留肾单位手术的临床疗效,总结手术经验。方法回顾性分析2010年8月至2012年3月12例经后腹腔镜联合经腰小切口及超声辅助下行保留肾单位手术治疗中心型肾癌患者的临床资料。男9例、女3例,平均年龄(56.2±2.8)岁;肿瘤平均直径(2.2±1.4)cm。术前均经超声、CT、MRI或CT动脉造影检查。患者全身麻醉后取健侧卧位,后腹腔镜常规方法游离出肾动脉、肾静脉及肾脏,切开腋后线与腋前线的两个Trocar之间的皮肤及肌肉,建立小切口,将超声探头从小切口置于肾表面,对肿瘤进行定位并标记手术切缘,放置冰屑于肾周,行肾动脉阻断或动、静脉阻断下保留肾单位手术。结果 12例手术均获成功,手术平均时间(124.5±5.8)min,术中平均热缺血时间(26.3±8.6)min,术中平均出血量(65.8±21.6)mL。切缘阴性率100%,平均手术切口(8.8±2.4)cm,术后平均住院时间(12.4±2.6)d;术后无并发症发生。随访平均(13.6±7.4)个月,未见肿瘤复发及转移。结论后腹腔镜联合经腰小切口及超声辅助下对中心型肾癌行保留肾单位手术具有创伤小、出血少、热缺血时间短、恢复快的优点,是一种安全、有效的治疗方法,具有良好的临床应用前景。
Objective To evaluate the clinical efficacy of retroperitoneal laparoscopic combined with lumbar incision and ultrasound-assisted central nephropathy in preserving nephron surgery and to summarize the surgical experience. Methods The clinical data of 12 patients with central renal cell carcinoma who underwent retroperitoneal laparoscopy combined with ultrasound-assisted nephron-assisted nephron surgery from August 2010 to March 2012 were retrospectively analyzed. There were 9 males and 3 females, with an average age of (56.2 ± 2.8) years; mean tumor diameter (2.2 ± 1.4) cm. Preoperative ultrasound, CT, MRI or CT angiography. After general anesthesia, the patient was taken to the lateral position and laparoscopic conventional method to free the renal artery, renal vein and kidney. The skin and muscle between the two Trocar of the axillary line and axillary line were incised and a small incision was made. The probe was placed on the surface of the kidney from a small incision, the tumor was located and marked surgical margins, placed in the nephrotic nests of ice, renal artery occlusion or arterial and venous occlusion retained nephron surgery. Results All the 12 cases were operated successfully. The average operation time was 124.5 ± 5.8 min, the mean intraoperative warm ischemia time was 26.3 ± 8.6 min, and the mean intraoperative blood loss was 65.8 ± 21.6 mL. The marginal negative rate was 100%, mean operative incision (8.8 ± 2.4) cm and average postoperative hospital stay (12.4 ± 2.6) days. No postoperative complication occurred. The average follow-up (13.6 ± 7.4) months, no tumor recurrence and metastasis. Conclusions Retroperitoneal laparoscopic combined with small incision and ultrasound assisted central nephridial nephrectomy is a safe and effective method to treat nephrons with small trauma, less bleeding, short warm ischemia and fast recovery. , Has good clinical application prospects.