腹腔镜下改良肾部分切除术治疗巨大囊性肾肿物

Modified laparoscopic partial nephrectomy in treatment of giant cystic renal masses

摘要:

目的 探讨腹腔镜下联合吸引的改良肾部分切除术治疗巨大囊性肾肿物的疗效与安全性。方法 共收治11例巨大囊性肾肿物患者，肿瘤最大径60~130 mm，平均（83±23） mm，影像学检查诊断为Bosniak分级Ⅲ~Ⅳ级。术中在经腹膜后或经腹腔入路腹腔镜视野下操作，分离出肾动脉备用，并尽可能分离肿物表面，然后在菲薄处用针状吸引杆吸净囊液，并将针孔处密闭。进一步完整游离出肿瘤，阻断肾动脉，行肾部分切除术。采用双层连续缝合技术，缝合肾脏创面。收集患者围手术期资料及术后随访情况。结果 所有手术均顺利完成，无中转开放或根治。平均手术时间（162±42） min，平均热缺血时间（24.0±5.3） min，平均出血量（107±79） mL，术后平均住院时间（6.7±1.7） d。病理结果显示透明细胞肾细胞癌7例、乳头状肾细胞癌1例、黄色肉芽肿性肾盂肾炎1例、良性复杂囊肿2例。术后中位随访时间21个月，无肿瘤复发或转移，肾功能情况良好。结论 腹腔镜下联合吸引的改良肾部分切除术治疗巨大囊性肾肿物的安全有效，适合以囊性成分为主、分隔较少的Bosniak Ⅲ~Ⅳ级的病例。

Abstract:

Objective To investigate the efficacy and safety of modified laparoscopic partial nephrectomy combined with suction in the treatment of giant cystic renal masses.Methods A total of eleven patients with giant cystic renal masses were admitted，with a maximum tumor diameter of 60-130 mm and a mean diameter of （83±23） mm，and radiological examination showed Bosniak grade Ⅲ-Ⅳ cystic renal masses. During the procedure，the renal artery was separated under the laparoscopic visual field through a retroperitoneal or intraperitoneal approach，and the exophytic portion of the cystic mass was separated as much as possible. Then，a needle-shaped suction rod was used to suck out the cystic fluid at the thin area，and the needle hole was sutured or sealed. The tumor was further isolated completely，the renal artery was blocked，and partial nephrectomy was performed. The double-layer continuous suture technique was used for the suture of renal wound. Perioperative data and postoperative follow-up data were collected.Results All patients underwent a successful surgery，with no patients converted to open surgery or receiving radical treatment. The patients had a mean time of operation of （162±42） minutes，a mean warm ischemia time of （24.0±5.3） minutes，a mean blood loss of （107±79） mL，and a mean postoperative hospital stay of （6.7±1.7） days. Pathological examination showed clear cell renal cell carcinoma in seven patients，papillary renal cell carcinoma in one patient，xanthogranulomatous pyelonephritis in one patient，and benign complex cysts in two patients. No tumor recurrence or metastasis was observed during a median follow-up time of 21 months after surgery，and the patients had good renal function.Conclusion Modified laparoscopic partial nephrectomy combined with suction is a safe and effective method for the treatment of giant cystic renal masses and is suitable for Bosniak grade Ⅲ-Ⅳ cystic masses mainly with cystic components and a few septa.