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目的探讨腹腔镜保留肾单位手术(LNSS)治疗T1期肾癌的手术特点和临床疗效。方法回顾性分析48例行腹腔镜保留肾单位手术治疗T1期肾癌患者的临床资料。其中男性32例,女性16例,年龄43～61岁,平均(54±1.8)岁;对侧肾脏正常39例,对侧肾脏存在疾患9例;肿瘤直径1.5～4.0cm,平均(2.3±0.6)cm;28例行后腹腔镜保留肾单位手术,20例行经腹腔途径腹腔镜保留肾单位手术。术后每3个月行腹部CT、肾脏ECT、超声及尿常规、肾功能检查。结果 48例手术均顺利完成,无中转开放。手术时间65～140min,平均(110±15)min;热缺血时间16～40min,平均(25±4)min;出血量50～500ml,平均(150±22)ml;术后留置引流管3～7d,平均(5±0.6)d;术后住院8～12d,平均(10±0.8)d。术后病理报告:肾透明细胞癌39例,乳头状肾细胞癌6例,肾嫌色细胞癌3例。术后无尿漏、继发性出血等并发症。随访10～25个月,平均(16.8±3.5)个月,5例术后1个月双肾总肾小球滤过率(GFR)出现轻度下降,术后3个月恢复正常,48例均无肿瘤局部复发或远处转移。结论腹腔镜保留肾单位手术治疗T期肾癌安全、有效,具有较好的临床应用价值。
Objective To investigate the surgical characteristics and clinical efficacy of laparoscopic nephron-sparing nephron (LNSS) in the treatment of stage T1 renal cell carcinoma. Methods The clinical data of 48 patients with T1 renal cell carcinoma undergoing laparoscopic nephron surgery were retrospectively analyzed. There were 32 males and 16 females, ranging in age from 43 to 61 years with an average of (54 ± 1.8) years. The contralateral kidney was normal in 39 cases and the contralateral kidney in 9 cases. The tumor diameter was 1.5-4.0 cm (mean, 2.3 ± 0.6) ) cm. Nephron surgery was performed in 28 patients with laparoscopic nephron surgery and nephron surgery was performed in 20 patients. Abdominal CT, renal ECT, ultrasound and urine routine and renal function tests were performed every 3 months after operation. Results All the 48 surgeries were successfully completed without any transit. The average time was 65 minutes to 140 minutes (mean, 110 ± 15) minutes. The warm ischemia time was 16-40 minutes (mean, 25 ± 4 minutes) ~ 7 days, with an average of (5 ± 0.6) days. The patients were hospitalized for 8-12 days with an average of (10 ± 0.8) days. Postoperative pathology report: 39 cases of clear cell renal cell carcinoma, 6 cases of papillary renal cell carcinoma and 3 cases of chromophobe renal cell carcinoma. No postoperative urinary leakage, complications such as secondary bleeding. All cases were followed up for 10-25 months with an average of (16.8 ± 3.5) months. Five patients had a slight decrease of total glomerular filtration rate (GFR) at 1 month after operation and returned to normal at 3 months. 48 cases No local tumor recurrence or distant metastasis. Conclusions Laparoscopic nephron surgery is a safe and effective method for the treatment of stage T renal cell carcinoma and has good clinical value.