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目的:评估不阻断肾动脉腹腔镜肾部分切除术治疗肾肿瘤的可行性和临床效果。方法:2016年1~11月于我院行不阻断肾动脉腹腔镜肾部分切除术的肾肿瘤患者12例,收集所有患者临床资料。其中男7例(58.33%),女5例(41.67%),平均年龄55.6(34~75)岁,平均体重指数27.4(21.5~32.3)kg/m2,所有患者均为单侧单发肾肿瘤,对侧肾功能正常,肿瘤均为部分外生性生长,平均直径2.9(1.5~5.0)cm,肾实质内深度≤2cm,肿瘤边缘距集合系统距离≥7mm,R.E.N.A.L.评分为4.6(4~6)分。术中常规置入辅助Trocar,由助手使用吸引器保持视野清晰。瘤体较大者,在切缘外预缝线,缩短进针、持针时间以减少出血量。对于创面内血管分支可预先以Hem-o-Lock夹闭,出血明显处用吸引器压迫待肿瘤切除后再行处理。结果:除2例患者因术中出血难以控制暂时阻断肾动脉后完成手术,其余10例患者均未阻断肾动脉,无中转开放手术。其中8例经后腹腔途径完成,4例采用经腹途径完成。手术时间75~121min,平均108min;出血量50~400ml,平均150ml;术后住院时间5~8d,平均6.6d;术后无肾脏继发出血、漏尿等外科并发症。病理报告肾透明细胞癌11例,肾错构瘤1例。结论:不阻断肾动脉腹腔镜肾部分切除术对于经过R.E.N.A.L.评分系统筛选过的低度复杂性肿瘤患者安全可行,可以通过避免肾脏缺血而保护肾功能,有较好的临床应用价值。
OBJECTIVE: To assess the feasibility and clinical efficacy of non-blocking renal artery laparoscopic partial nephrectomy in the treatment of renal tumors. Methods: From January to November 2016, 12 patients with renal tumors who did not block renal artery laparoscopic partial nephrectomy in our hospital were collected. Clinical data of all patients were collected. There were 7 males (58.33%) and 5 females (41.67%), with an average age of 55.6 (34-75) and an average body mass index of 27.4 (21.5-32.3) kg / m2. All patients were single-sided single kidney tumors , The contralateral kidney function was normal, the tumors were some of the exogenous growth, the average diameter of 2.9 (1.5 ~ 5.0) cm, the depth of the renal parenchyma ≤ 2cm, the tumor margin from the collection system ≥ 7mm, RENAL score of 4.6 (4 ~ 6) Minute. Auxiliary Trocar was routinely inserted during surgery, with the aid of an aspirator to maintain a clear field of view. Larger tumor, pre-suture in the margin, shorten the needle, needle-holding time to reduce the amount of bleeding. For the vascular branch of the wound can be pre-Hem-o-Lock clamping, bleeding was obviously treated with a suction device to be treated before tumor resection. Results: Except for 2 patients who had intractable hemorrhage, it was difficult to control the renal artery and temporarily blocked the operation. The other 10 patients did not block the renal artery, and no open surgery was performed. Among them, 8 cases were completed by retroperitoneal approach and 4 cases were completed by transabdominal approach. The operation time was 75-121min, with an average of 108min. The amount of bleeding was 50-400ml, with an average of 150ml. The postoperative hospital stay was 5-8 days, with an average of 6.6 days. No postoperative complications such as secondary bleeding and leakage of urine were found. Pathological reports of renal clear cell carcinoma in 11 cases, renal hamartoma in 1 case. CONCLUSION: Non-blocking renal artery laparoscopic partial nephrectomy is safe and feasible for patients with low-complexity tumors screened by R.E.N.A.L. scoring system. It can protect renal function by avoiding renal ischemia and has good clinical value.