摘要
目的分析后腹腔镜肾部分切除术(laparoscopic partial nephrectomy, LPN)治疗T1a期肾门旁肿瘤的安全性和有效性。方法回顾性分析2008年9月至2018年5月间LPN治疗11例肾门旁肿瘤患者的资料。收集患者的一般情况、临床资料、影像学资料、手术结果、病理结果和随访结果。结果 11例患者的中位年龄46(26～75)岁,中位肿瘤直径3.0(2.3～4.0)cm,中位R.E.N.A.L评分5(4～7)分。临床分期均为T1aN0M0。全部患者成功完成手术,中位热缺血时间35(23～56)min,中位手术时间180(150～240)min,中位估计失血量为100(50～300)mL。3例患者术中行集合系统修补术。术后1例输血,2例短暂性血尿,1例低热,1例出现漏尿,保守治疗后好转;中位术后住院时间7(5～13)d;术后病理诊断:透明细胞癌8例,嫌色肾细胞癌1例,乳头状肾细胞癌1例,血管平滑肌脂肪瘤1例。10例肾细胞癌(renal cell carcinoma, RCC)术后病理分期均为T1aN0M0。4例患者术中做切缘活检,结果均阴性。术后中位随访时间33(1～80)个月,均未出现局部复发或转移。结论对于T1a期的肾门旁肿瘤,LPN是安全可行的手术方式,熟练的腹腔镜技术和术者的临床经验是手术成功的重要因素。
Objective To investigate the safety and feasibility of trans-retroperitoneal laparoscopic partial nephrectomy (LPN) for T1a hilar tumor. Methods The data of 11 patients with hilar tumor who received trans-retroperitoneal LPN treatment from September 2008 to May 2018 were reviewed and analyzed retrospectively.The patients' characteristics,tumor characteristics,the outcomes of operations,histopathology and follow-up reports were carefully recorded. Results The median age of the 11 patients was 46(26-75) years,the median tumor size was 3.0(2.3-4.0)cm,and the median RENAL nephrometry score was 5(4-7) points.Each patient had clinical T1aN0M0 disease.LPN was successfully performed on all the patients.The median warm ischemia time was 35(23-56)min,the median operation time was 180(150-240)min,and the median estimated blood loss was 100(50- 300)mL.Collecting system repair was made on three patients.One patient required postoperative blood transfusion.Two patients had temporary hematuria.Mild fever was detected in one patient postoperatively.One patient had urine leaking for a short period of time.The median hospitalization duration was 7(5-13)d.Final histology showed that 10 excised lesions were RCC,with 8 clear cell subtype,1 chromophobe subtype and 1 papillary subtype.All with RCC had pathological T1aN0M0 disease.The remaining one lesion was angioleiomyolipoma.Margin biopsy was performed on four patients,and all had negative margins.The median follow-up time was 33(1-80) months,no patients developed local recurrence or metastasis. Conclusion LPN for T1a hilar tumor can be performed safely and effectively on well-selected patients by experienced operator.
作者
王欢
种铁
李波涌
李斌
李美霞
李雯
陆弦
郑文博
WANG Huan;CHONG Tie;LI Bo-yong;LI Bin;LI Mei-xia;LI Wen;LU Xian;ZHENG Wen-bo(Department of Urology,The Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004;Department of Urology,The First Hospital of Yueyang City,Yueyang 414000,China)
出处
《西安交通大学学报（医学版）》
CAS
CSCD
北大核心
2019年第3期451-454,485,共5页
Journal of Xi’an Jiaotong University（Medical Sciences）
