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目的探讨后腹腔镜下保留肾单位手术治疗肾错构瘤的方法和临床价值。方法选取术前影像学诊断为肾错构瘤患者14例,行后腹腔镜下肾错构瘤剜除术,术中充分游离肿瘤,对小而表浅肿瘤不阻断肾血管,超声刀直接切除。对大而较深肿瘤阻断肾动脉血流,记录血流阻断时间,利用剪刀锐性切除、吸引器负压吸除肿瘤组织,可吸收线缝合肾创缘。结果 14例患者均成功完成手术,手术时间70-170min。10例行肾蒂血流阻断,阻断时间平均30min;4例未阻断肾血流,直接切除肿瘤,出血量平均100ml。早期1例术后6h合并出血,改开放手术缝合肾创缘成功止血;1例术后尿漏,通畅引流,保守治疗痊愈。术后随访无肿瘤复发,患肾功能正常。结论后腹腔镜下肾错构瘤剜除术创伤小,患者恢复快。但腹腔镜下切除,缝合技术要求较高,应选择合适病例,掌握适应证。
Objective To investigate the method and clinical value of retroperitoneal laparoscopic surgery for nephrotic nephroma. Methods Preoperative imaging diagnosis of renal hamartoma in 14 patients underwent retroperitoneal laparoscopic nephrostomy, full of free intraoperative tumor, the small and superficial tumors do not block the renal blood vessels, ultrasound scalpel direct resection. Large and deep tumors blocking the renal artery blood flow, recording blood flow blocking time, the use of scissors sharp excision, vacuum suction suction tumor tissue can absorb suture wound edge. Results All the 14 patients completed the operation successfully, the operation time was 70-170min. 10 cases of renal pedicle block blood flow, blocking time average 30min; 4 cases did not block renal blood flow, direct tumor removal, the average amount of bleeding 100ml. In the early stage, one patient had hemorrhage at 6h after operation, and succeeded in stopping hemorrhage by suturing the kidney with suture operation. One patient had excretion of urine and drainage, which was cured by conservative treatment. No tumor recurrence after surgery, normal renal function. Conclusions Retroperitoneal laparoscopic nephrostomy is less invasive and patients recover faster. However, laparoscopic resection, suture technique requires higher, should choose the appropriate case, to grasp indications.