后腹腔镜保留肾单位手术治疗70岁以上老年局限性肾癌

发布时间：2019-01-07 17:24

【摘要】：目的探讨后腹腔镜保留肾单位手术治疗70岁以上老年局限性肾癌的疗效。方法 2011年9月~2014年12月对16例70岁以上肾癌行后腹腔镜肾部分切除术。建立后腹腔气腹后分别置入3枚trocar,打开侧椎筋膜,在腰大肌与肾脂肪囊间分离,上至膈肌,下至输尿管。游离肾脏中部,找到肾动脉,找到并游离肿物,置入血管阻断钳夹闭肾动脉,剪刀距肿瘤边缘0.5 cm切除肿物及部分肾实质,3-0可吸收线缝合集合系统(肿瘤位置较深邻近集合系统者),以2-0倒刺线连续贯穿缝合肾实质,缝合完毕后以Hem-o-lok夹固定。松开血管阻断钳,出血部分加强缝合。结果 16例手术均成功完成,无中转开放。手术时间55~240 min,(132.4±46.4)min,血管阻断时间12~40 min,(25.3±7.6)min;术中出血量10~200 ml,(79.7±62.6)ml,无输血。术后住院时间6~15 d,(9.4±3.2)d。16例随访(30.8±9.5)月,1例术后24个月因全身肿瘤转移死亡,1例术后31个月因心脏疾病死亡,其余患者无复发、转移。1例术后18个月出现肾功能衰竭,规律行腹膜透析。结论后腹腔镜保留肾单位手术治疗70岁以上老年局限性肾癌安全有效,条件允许时推荐采用。
[Abstract]:Objective to evaluate the efficacy of retroperitoneal laparoscopic nephron-sparing surgery in the treatment of localized renal cell carcinoma (RCC) in elderly patients over 70 years old. Methods from September 2011 to December 2014, 16 cases of renal carcinoma over 70 years old were treated with retroperitoneal laparoscopic partial nephrectomy. After the establishment of posterior abdominal pneumoperitoneum, three trocar, were placed respectively to open the lateral vertebral fascia and separate between the psoas major muscle and the renal fat sac, from the diaphragm to the ureter. In the middle of the free kidney, the renal artery was found, the tumor was found and free, and the occluded renal artery was clamped by vascular occlusion. The tumor and some renal parenchyma were removed with scissors 0.5 cm from the edge of the tumor. The 3-0 absorbable suture system (where the tumor is located in the deep vicinity of the collection system) was sutured with 2-0 inverted line through the renal parenchyma and fixed with Hem-o-lok clip after suture. Release the vascular clamping forceps and strengthen the suture of the bleeding part. Results all the 16 cases were successfully completed, and there was no transition to open. The operation time was 55 ~ 240 min, (132.4 卤46.4) min, the blood loss was 10 ~ 200 ml, (79.7 卤62.6) ml, and the blood loss was 10 ~ 200 ml, (25.3 卤7.6) min; without blood transfusion. The postoperative hospitalization time was 6 ~ 15 days, (9.4 卤3.2) d.16 cases were followed up (30.8 卤9.5) months. One case died of systemic tumor metastasis 24 months after operation, one case died of heart disease 31 months after operation, and the other patients did not recur. Metastasis. Renal failure occurred in 1 case 18 months after operation, and peritoneal dialysis was performed regularly. Conclusion retroperitoneal laparoscopic nephron-sparing surgery is safe and effective in the treatment of local renal cell carcinoma over 70 years old.
【作者单位】：四川省医学科学院·四川省人民医院泌尿外科;
【分类号】：R737.11

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