肾蒂旋转法辅助治疗后腹腔镜下腹侧肾肿瘤的肾部分切除术

发布时间：2018-04-01 15:52

  本文选题：肾肿瘤　切入点：后腹腔镜　出处：《北京大学学报(医学版)》2017年04期

【摘要】：目的:为降低后腹腔镜入路的腹侧肾部分切除术手术难度,减少手术风险,总结归纳并发展后腹腔镜入路肾部分切除术的肾蒂旋转法及相关技术。方法:总结归纳并发展一整套针对腹侧肾门区肾肿瘤的肾蒂旋转法操作技术,包括肾蒂旋转、双层缝合、早期开放动脉等。该技术有助于实施后腹腔入路的肾部分切除术,手术效果的评价由手术时间、热缺血时间、术中出血量、手术切缘、术后肾功能、手术并发症等组成。本研究回顾性分析中南大学湘雅医院28例腹侧肾肿瘤患者资料,其中15例为较复杂的肾门区肿瘤。结果:平均肿瘤大小为(3.8±0.5)cm,平均R.E.N.A.L评分为8(范围7~9)。手术中平均热缺血时间(23.8±4.7)min,缝合时间(26.2±6.5)min,估计失血量(139.1±54.0)m L,手术时间(124.1±12.1)min,中位住院天数为4 d。7例患者出现Clavien DindoⅠ~Ⅱ级并发症,所有患者病理检查均示切缘阴性,中位随访7个月无局部复发或远处转移。结论:对于腹侧肾肿瘤,尤其是位于肾门区的肾肿瘤,利用肾蒂旋转法行后腹腔镜下肾部分切除术是安全有效的;短时间随访结果较乐观,但需长时间随访。
[Abstract]:Objective: to reduce the difficulty and risk of retroperitoneal laparoscopic partial nephrectomy. Methods: to summarize and develop a set of renal pedicle rotation techniques for renal tumors in the ventral hilar area, including pedicle rotation and double suture. Early open artery, etc., this technique can be used to perform partial nephrectomy via retroperitoneal approach. The operative effect is evaluated by the time of operation, the time of hot ischemia, the amount of blood lost during operation, the margin of operation, the function of kidney after operation, and so on. The data of 28 patients with ventral renal tumor in Xiangya Hospital of Central South University were retrospectively analyzed. Results: the mean tumor size was 3. 8 卤0. 5 cm and the average R.E.N.A.L score was 8 (range 7? 9). The mean warm ischemia time was 23. 8 卤4. 7 min, the suture time was 26. 2 卤6. 5 min, the estimated blood loss was 139.1 卤54. 0 mL, the operation time was 124.1 卤12. 1 min, and the median hospitalization time was 12. 1 卤12. 1 min. Clavien Dindo grade 鈪，

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