摘要
目的：探讨后腹腔镜保留肾单位手术治疗肾脏大错构瘤的改进方法。方法：利用换位思考的思维方法,提出＂先肾部分切除,后游离肿瘤＂的新策略。2011年4月至2015年3月共完成16例此类手术,肿瘤6.2-12.4 cm。分离肾动脉后,先行肾实质的彻底游离,再阻断肾动脉后完成肾部分切除术。关闭肾脏创面,恢复血供并妥善止血后,再行错构瘤瘤体的切除。结果：15例手术获得成功,1例因创面较大,缝合后肾脏血供不佳而改为肾脏切除术。手术时间74-200 min,肾脏热缺血时间16-44 min,术中出血量25-300 ml。结论：换位思考,颠倒操作次序可减少瘤体分离时破裂出血的可能,降低分离难度。精确的术前判断、合理的手术策略加上手术技巧的改进,可提高腹腔镜肾脏大错构瘤部分切除术的成功率。
Objective： To illustrate a new strategy of retroperitoneal laparoscopic nephron sparing surgery（ NSS） for large renal angiomyolipoma（ R-AML）. Methods： A retrospective review of data of retroperitoneal laparoscopic NSS for large R-AML（ ≥6 cm）was performed between Apr. 2011 and Mar. 2015. A total of 16 procedures with tumor size ranged from 6. 2 cm to 12. 4 cm were scheduled（ 12 females and 4 males）. The novel transpositional strategy was performed-surgeons excised the kidney from the mass firstly,then dissected and peeled（ removed） the whole mass off. In the surgery,renal parenchyma was dissected as much as possible after dissection of renal artery,but the mass not. Then the kidney was excised from the tumor mass with the renal artery clamped. After renal reconstruction and blood recovery,the whole mass was peeled off safely,without any blood supply. Results： Fifteen procedures were successfully done,and none of the cases required conversion to open surgery. However,one case,which close to the renal hilar,was converted to nephrectomy for the pool renal blood supply of residual kidney. The operative time was 74-200 min. The warm ischemia time was 16-44 min. The estimated blood loss was 25-300 ml. Conclusions： The new strategy could decrease the possibility of the rupture and bleeding of the mass,may reduce the difficulty of whole operation. And accurate preoperative judgment,reasonable operation strategy,improved surgical techniques can improve the success rate of retroperitoneal laparoscopic NSS for large R-AML（ ≥6 cm）,which will be another choice for these cases.
出处
《腹腔镜外科杂志》
2016年第2期145-148,共4页
Journal of Laparoscopic Surgery
