摘要
目的:探讨孤立肾肾肿瘤保肾治疗策略的选择。方法:回顾本中心2017年2月—2022年3月收治孤立肾肾肿瘤患者41例,男28例,女13例,年龄59(27~79)岁。其中38例为体检或术后复查中发现,2例患者因血尿就诊,1例患者因腰腹部肿块就诊。肿瘤位于左肾14例,右肾27例,其中肾门部肿瘤2例,肿瘤直径24(8~75) mm。所有患者均在气管插管全麻下进行,其中4例行开放肾部分切除术,19例行腹腔镜肾部分切除术,11例行机器人辅助腹腔镜肾部分切除术,3例行小切口辅助腹腔镜肾部分切除术,4例行腹腔镜肾肿瘤微波消融术。记录手术时间、出血量、肾动脉阻断方式、肾动脉阻断时间、术中及术后并发症、术前及出院前血肌酐值、住院时间。结果:所有手术均安全顺利完成,无术中并发症发生,2例腹腔镜肾部分切除术采用分支动脉阻断,其余肾部分切除术均采用肾动脉主干阻断,腹腔镜肾肿瘤微波消融术均无阻断。2例患者出现术后并发症。开放肾部分切除术组、腹腔镜肾部分切除术组、机器人肾部分切除术组、小切口辅助腹腔镜肾部分切除术组及腹腔镜微波消融组中位手术时间(173 min vs 135 min vs 120 min vs 260 min vs 68 min),中位出血量(250 mL vs 100 mL vs 50 mL vs 300 mL vs 30 mL),中位肾动脉阻断时间(30 min vs 20 min vs 20 min vs 28 min vs 0 min)。肾部分切除术术后病理示所有病例均切缘阴性。不同术式的肾部分切除术出院前肌酐均较术前肌酐有不同程度升高。结论:不同术式的肾部分切除术及消融技术均是孤立肾肾肿瘤安全有效的治疗方式。患者基础情况佳,优选微创肾部分切除术。患者基础情况差且肿瘤体积较小为外生型肿瘤优选消融治疗。对于肿瘤分期高,肿瘤侵犯周围组织器官或伴邻近组织器官转移,或既往术区有手术史的患者,开放手术或小切口辅助腹腔镜手术依旧是该类患者的优选方案。
Objective:To explore the selection of nephron-sparing surgery for tumors in a solitary kidney.Methods:Between February 2017 and March 2022,41 patients(28 males and 13 females),aged 59(27-79) y,with tumors in a solitary kidney were treated in our center.Thirty-eight cases were found in physical examination or postoperative reexamination,two cases were treated for hematuria,and 1 case was treated for abdominal mass.The tumors were located in the left kidney in 14 cases,in the right kidney in 27 cases,and 2 cases with hilar tumors.The tumor diameters were 24(8-75) mm.All patients were operated under general anesthesia.Four cases were performed by open partial nephrectomy,nineteen cases were performed by laparoscopic partial nephrectomy,eleven cases were performed by robot assisted laparoscopic partial nephrectomy,three cases were performed by small incision assisted laparoscopic partial nephrectomy,and 4 cases were performed by laparoscopic microwave ablation of renal tumors.The operation time,blood loss,renal artery blocked mode,renal artery blocked time,intraoperative and postoperative complications,preoperative and discharge blood creatinine values,and hospital stay were recorded.Results:All the operations were completed safely and smoothly without intraoperative complications.Two cases of laparoscopic partial nephrectomy were blocked by branch arteries,and the rest were blocked by renal artery.Laparoscopic microwave ablation of renal tumors were not blocked.Postoperative complications occurred in 2 patients.The median operation time were(173 min vs 135 min vs 120 min vs 260 min vs 68 min) and the median bleeding volume were(250 mL vs 100 mL vs 50 mL vs 300 mL vs 30 mL) in the open group,laparoscopic group,robot group and small incision assisted laparoscopic group,respectively.Median renal artery occlusion time were(30 min vs 20 min vs 20 min vs 28 min vs 0 min),respectively.The creatinine before discharge of different types of partial nephrectomy were higher than those before operation.Conclusion:Different types
作者
过菲
张超
吴震杰
肖成武
汪洋
张威
方玉
杨波
王林辉
GUO Fei;ZHANG Chao;WU Zhenjie;XIAO Chengwu;WANG Yang;ZHANG Wei;FANG Yu;YANG Bo;WANG Linhui(Department of Urology,Changhai Hospital,First Affiliated Hospital of Naval Medical University,Shanghai,200433,China)
出处
《临床泌尿外科杂志》
CAS
2022年第9期680-684,共5页
Journal of Clinical Urology
关键词
孤立肾
肾肿瘤
保肾治疗
solitary kidney
renal tumor
nephron-sparing surgery
