后腹腔镜肾部分切除术治疗早期肾肿瘤并发症研究

发布时间：2018-06-08 18:21

本文选题：早期肾肿瘤 + 后腹腔镜　；参考：《南昌大学》2017年硕士论文

【摘要】：目的:为了探讨经后腹腔入路腹腔镜肾部分切除术治疗的早期肾肿瘤并发症,评价该术式的安全性及疗效,为临床治疗早期肾肿瘤术式的选择提供参考资料和方法:收集中国人民解放军第175医院泌尿外科2014年2月~2016年6月期间收住院22例早期肾肿瘤患者行后腹腔镜下肾部分切除术(RLPN)治疗临床资料,男性16例,女性6例,平均年龄约44.2(25~62)岁;其肿瘤大小0.4cm~1.7cm×2.6cm~5.5 cm,平均约1.1cm×3.7cm。所有患者术前均行增强CT明确诊断,部分患者根据血肌酐水平行ECT检查,并测量瘤体最大直径。严格按照纳入标准及排除标准筛选病例,记录手术时间、失血量、输血率、热缺血时间、术中相关并发症、围手术期情况、术后并发症、随访肾功能恢复和生存期情况等观察指标,评价RLPN治疗早期肾肿瘤的安全性和疗效。结果:(1)手术情况:均顺利完成手术,无1例中转开放手术。手术时间90~152min,平均117.3min,热缺血时间20~38min,平均28.5min;术中出血量200~400ml,平均267.7ml,术中输血1例;术后导尿管、引流管均成功拔除;(2)术后病理学检查结果:透明细胞癌14例(肿瘤表面脂肪组织受浸润1例、肿瘤细胞浸润包膜2例);肾血管平滑肌脂肪瘤5例;乳头状肾细胞癌3例;术中假包膜破裂1例。(3)随访情况:出院后获随访19例,随访时间3~20个月,平均11个月;失访3例。住院术后第3天肾功能恢复正常15例,随后半年至1年期间,肾功能不全2例。肺部转移1例,无死亡报道。(4)并发症情况:后腹膜破裂3例;肾血管牵拉伤1例;松解血管夹后少量渗血3例。术后所有患者均述切口痛影响睡眠;皮下气肿3例。肺部感染2例。结论:1采用经腹膜后入路行腹腔镜肾部分切除术治疗早期肾肿瘤,具有解剖游离迅速,耗时更短、对胃肠道功能干扰轻等优点。2确保手术疗效的同时,并未增加术中术后出血、术后漏尿、肾功能不全、肾周组织副损伤等并发症发生率,进一步证实经腹膜后入路行腹腔镜肾部分切除术治疗早期肾肿瘤是安全有效的术式。
[Abstract]:Objective: to evaluate the safety and efficacy of laparoscopic partial nephrectomy in the treatment of early renal tumor complications. To provide references and methods for the selection of surgical procedures for early renal neoplasms: from February 2014 to June 2016, 22 patients with early renal neoplasms received retroperitoneal laparoscopy in the Urology Department of the 175th Hospital of the Chinese people's Liberation Army (PLA) from February 2014 to June 2016. Clinical data of partial nephrectomy with RLPN There were 16 males and 6 females, with an average age of 44.2 / 25 (62) years, and the tumor size was about 0.4cm~1.7cm 脳 2.6cm~5.5 cm, with an average of 1.1cm 脳 3.7 cm. All patients were diagnosed by enhanced CT before operation, and some patients were examined by ECT according to serum creatinine level, and the maximum diameter of tumor was measured. Select cases according to inclusion criteria and exclusion criteria strictly, record the operation time, blood loss, blood transfusion rate, hot ischemia time, intraoperative complications, perioperative conditions, postoperative complications, To evaluate the safety and efficacy of RLPN in the treatment of early renal tumors. Results: the operation was completed successfully, and no one was transferred to open operation. The mean operation time was 117.3 min, the mean time of operation was 117.3 min, the mean time of hot ischemia was 20 min (28.5 min), the volume of blood loss during operation was 200,400 ml (mean 267.7 ml), the intraoperative transfusion was 1 case, the postoperative urethral catheter, The results of pathological examination were as follows: 14 cases of clear cell carcinoma (1 case of infiltration of tumor surface adipose tissue, 2 cases of tumor cell infiltrating capsule), 5 cases of renal angiomyolipoma, 3 cases of papillary renal cell carcinoma, 5 cases of renal angiomyolipoma, 3 cases of papillary renal cell carcinoma, 5 cases of renal angiomyolipoma and 3 cases of papillary cell carcinoma. 1 case with false capsule rupture during operation: 19 cases were followed up after discharge, the average follow-up time was 11 months, 3 cases were lost. Renal function returned to normal in 15 cases on the 3rd day after hospitalization, and renal insufficiency occurred in 2 cases from 6 months to 1 year later. 1 case of pulmonary metastasis, no death report. 4) complications: 3 cases of posterior peritoneal rupture, 1 case of renal vascular pulling injury, 3 cases of small amount of blood leakage after decompression of blood vessels. All postoperative patients reported incision pain affecting sleep, 3 cases of subcutaneous emphysema. Pulmonary infection in 2 cases. Conclusion the retroperitoneal laparoscopic partial nephrectomy for early renal neoplasms has the advantages of rapid anatomic dissociation, shorter time consuming, less disturbance of gastrointestinal function, and so on, while ensuring the curative effect of the operation, and does not increase the intraoperative and postoperative bleeding at the same time. The incidence of complications such as leakage of urine, renal insufficiency, perirenal tissue injury and other complications further confirmed that laparoscopic partial nephrectomy via retroperitoneal approach is a safe and effective procedure for the treatment of early renal tumors.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.11

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