微波消融辅助腹腔镜下肾部分切除术治疗大于4cm肾错构瘤的初步体会

发布时间：2018-07-22 14:00

【摘要】：目的:探讨微波消融辅助腹腔镜下肾部分切除术(microwave ablation assisted laparoscopic partial nephrectomy,MWA-LPN)治疗肾错构瘤的可行性及临床疗效。方法:回顾性分析2013年5月—2016年5月收治的经MWA-LPN治疗的49例直径4 cm肾错构瘤患者的临床资料。男23例,女26例。年龄26~78岁,平均52.4岁。肿瘤最大直径5.0~13.0 cm,平均8.2 cm。术前患肾平均肾小球滤过率(glomerular filtration rate,GFR)为(43±16)m L/(min·1.73 m2)。所有患者都采用经后腹腔途径,应用KY-2000可控温杆微波消融仪,输出功率为80 W,每个周期消融时间1~3 min,共消融2~4个周期。消融结束后,沿肿瘤边缘锐性切除肿瘤。观察手术时间、术中出血量、术后并发症、术后住院时间及近期局部疗效。结果:49例手术顺利,无中转开放手术。平均手术时间(105.5±10.2)min,平均出血量(103.6±40.2)m L,1例患者术中输血,无术后出血病例。术后尿瘘2例。围手术期并发症发生率为6.1%。术后平均住院天数为(3.7±0.8)d。术后随访9~46个月,平均23.5个月。术后1个月复查GFR,平均(40±18)m L/(min·1.73 m2),与术前相比差异无统计学意义(P0.05)。术后1个月和6个月复查CT,均未发现局部复发。结论:MWA-LPN治疗大于4 cm肾错构瘤安全有效,可以作为肾错构瘤的治疗方式之一,但远期效果尚需进一步随访观察。
[Abstract]:Objective: to investigate the feasibility and clinical effect of microwave ablation assisted laparoscopic partial nephrectomy (microwave ablation assisted laparoscopic partial nephrectomytomyMWA-LPN) in the treatment of renal hamartoma. Methods: the clinical data of 49 patients with 4 cm diameter renal hamartoma treated with MWA-LPN from May 2013 to May 2016 were retrospectively analyzed. There were 23 males and 26 females. The average age was 52.4 years. The maximum diameter of the tumor was 5.0 ~ 13.0 cm, with an average of 8.2 cm. The mean glomerular filtration rate (glomerular filtration) was (43 卤16) mL / (min 1.73 m2). All patients were treated by retroperitoneal approach with KY-2000 thermostat microwave ablation instrument with output power of 80 w.The ablation time of each cycle was 1: 3 min. The ablation lasted 2 ~ 4 cycles. After ablation, the tumor is resected sharply along the edge of the tumor. The operative time, intraoperative bleeding volume, postoperative complications, postoperative hospitalization time and short-term local effect were observed. Results 49 cases were successfully operated, and there was no transition to open operation. The mean operative time was (105.5 卤10. 2) min and the mean blood loss was (103.6 卤40. 2) mL / min. No postoperative bleeding was found in 1 patient. Postoperative urinary fistula in 2 cases. The incidence of perioperative complications was 6.1. The average hospital stay was (3.7 卤0.8) days. Postoperative follow-up ranged from 9 to 46 months (mean 23.5 months). One month after operation, the mean value of GFR was (40 卤18) mL / (min 1.73 m2), which was not significantly different from that before operation (P0.05). After 1 month and 6 months, no local recurrence was found. Conclusion it is safe and effective to treat renal hamartoma with MWA-LPN greater than 4 cm. It can be used as one of the treatment methods for renal hamartoma, but the long-term effect needs to be further followed up.
【作者单位】：上海交通大学医学院附属仁济医院泌尿外科;
【基金】：国家自然科学基金(81402084,81472378) 仁济医院培育项目(PYZY16-006)
【分类号】：R737.11

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