后腹腔镜联合经腰小切口“杂交”手术在复杂肾肿瘤保留肾单位手术中的应用
发布时间：2018-10-12 17:32
【摘要】：目的:探讨后腹腔镜联合经腰小切口"杂交"手术在复杂肾肿瘤保留肾单位手术中的临床疗效和安全性。方法:回顾性分析2015年4月至2016年12月在北京大学人民医院泌尿外科进行"杂交"保留肾单位手术的复杂肾肿瘤患者的临床资料,其中男性10例,女性6例,年龄(50.2±10.7)岁,肿瘤位于左侧9例,右侧7例,肿瘤直径(6.1±1.0)cm,R.E.N.A.L.评分平均(9.3±1.3)分。患者均采用后腹腔镜联合经腰小切口的"杂交"手术方式进行保留肾单位手术,即在后腹腔镜下完全游离肾和肾蒂血管,预置肾动脉,然后取12肋下长约10~12 cm的切口进行开放手术,阻断肾动脉,直视下切除肿瘤、缝合创面。记录手术时间、肾缺血时间、术中出血量、术后并发症等围手术期资料以及术后肾功能随访情况。结果:16例均全部成功完成手术。手术时间(164.9±23.6)min,肾缺血时间(32.4±6.2)min,术中出血量(204.0±125.1)m L,引流管拔除时间(4.1±1.0)d,术后平均住院时间(6.9±1.5)d。术后发生ClavienⅢ级以上并发症2例:1例集合系统损伤;1例患者因术后出血,再次急诊手术探查止血。术后第1天平均血肌酐水平为(126.3±26.4)μmol/L,与术前(74.3±16.9)μmol/L比较,差异有统计学意义(P0.05)。术后1个月平均血肌酐水平为(92.6±18.2)μmol/L、术后3个月平均血肌酐水平为(80.8±18.4)μmol/L,与术前比较差异无统计学意义(P0.05)。随访3~20个月,均未见肿瘤复发和转移。结论:后腹腔镜联合经腰小切口"杂交"保留肾单位手术能够降低手术难度,提高手术安全性,适用于部分经过选择的复杂肾肿瘤患者,有一定的临床推广价值。
[Abstract]:Objective: to evaluate the clinical efficacy and safety of retroperitoneal laparoscopy combined with translumbar small incision hybridization in complicated renal tumor nephron sparing surgery. Methods: the clinical data of patients with complicated renal tumors undergoing "hybrid" nephron-sparing surgery in the Department of Urology, people's Hospital of Peking University from April 2015 to December 2016 were retrospectively analyzed, including 10 males and 6 females, aged (50.2 卤10.7) years. The tumor was located on the left in 9 cases and on the right in 7 cases. The diameter of the tumor was (6.1 卤1.0) cm,R.E.N.A.L.. The average score was (9.3 卤1.3). Retroperitoneal laparoscopy combined with "hybridization" through a small lumbar incision was used to perform nephron-sparing surgery, in which the renal artery was prepositioned by completely dissociating the kidney and renal pedicle vessels under retroperitoneal laparoscopy. Then the 12 subcostal incision, about 10 ~ 12 cm long, was opened to block the renal artery, the tumor was removed directly and the wound was sutured. The perioperative data such as operative time, renal ischemia time, intraoperative bleeding volume, postoperative complications and follow-up of postoperative renal function were recorded. Results: all the 16 cases were successfully operated. The operative time was (164.9 卤23.6) min, the mean time of renal ischemia was (32.4 卤6.2) min, the time of extubation of drainage tube was (204.0 卤125.1) m L, the average time of hospitalization was (6.9 卤1.5) days. There were 2 cases of complications above grade 鈪，
本文编号：2266998
[Abstract]:Objective: to evaluate the clinical efficacy and safety of retroperitoneal laparoscopy combined with translumbar small incision hybridization in complicated renal tumor nephron sparing surgery. Methods: the clinical data of patients with complicated renal tumors undergoing "hybrid" nephron-sparing surgery in the Department of Urology, people's Hospital of Peking University from April 2015 to December 2016 were retrospectively analyzed, including 10 males and 6 females, aged (50.2 卤10.7) years. The tumor was located on the left in 9 cases and on the right in 7 cases. The diameter of the tumor was (6.1 卤1.0) cm,R.E.N.A.L.. The average score was (9.3 卤1.3). Retroperitoneal laparoscopy combined with "hybridization" through a small lumbar incision was used to perform nephron-sparing surgery, in which the renal artery was prepositioned by completely dissociating the kidney and renal pedicle vessels under retroperitoneal laparoscopy. Then the 12 subcostal incision, about 10 ~ 12 cm long, was opened to block the renal artery, the tumor was removed directly and the wound was sutured. The perioperative data such as operative time, renal ischemia time, intraoperative bleeding volume, postoperative complications and follow-up of postoperative renal function were recorded. Results: all the 16 cases were successfully operated. The operative time was (164.9 卤23.6) min, the mean time of renal ischemia was (32.4 卤6.2) min, the time of extubation of drainage tube was (204.0 卤125.1) m L, the average time of hospitalization was (6.9 卤1.5) days. There were 2 cases of complications above grade 鈪，
本文编号：2266998
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