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目的:评价腹腔镜技术进行肾部分切除术的可行性及临床价值。方法:2005年3月~2011年7月,对经病理证实的145例肾癌患者,60例错构瘤患者在全麻下行后腹腔镜肾部分切除术。术中充分游离肿块;游离出肾动脉并用血管夹阻断(30 min内),用剪刀或超声刀切除肾占位肿块(切缘0.5~1.0 cm),保证肿块包膜完整;切面彻底止血,有血管出血缝扎止血;切开肾盂者,缝合关闭;然后全层兜底交错缝合切缘,缺损较大可用Hem-o-lok减张缝合。结果:所有患者均成功完成手术,手术时间60~150 min,平均80 min。阻断动脉10~30 min,平均20 min。术中出血量100~800 ml,平均200 ml,早期1例术后当晚出血,开放手术修复成功;2例术后缝合口出血,介入栓塞治疗满意;3例术后1~2周假性动脉瘤,介入栓塞治疗满意;无尿漏发生。其余恢复顺利,住院7~10天,平均8天,随访6~56个月,无肿瘤复发。结论:后腹腔镜肾部分切除术,创伤小、术后恢复快,明显优于开放手术,值得大力推广。但应注重基本功训练,严格掌握适应证。
Objective: To evaluate the feasibility and clinical value of laparoscopic partial nephrectomy. Methods: From March 2005 to July 2011, 145 cases of renal cell carcinoma confirmed by pathology and 60 cases of hamartoma underwent general laparoscopic partial nephrectomy under general anesthesia. Free intra-articular lumps were removed from the renal arteries and blocked with a vascular clip (within 30 min). Scissors or an ultrasonic knife were used to remove the mass-bearing tumor (margin 0.5-1.0 cm) to ensure the integrity of the tumor capsule. Bleeding bleeding suture hemostasis; those who cut the renal pelvis, suture closure; then full-duplex pocket staggered incision, defect larger available Hem-o-lok suture reduction. Results: All patients underwent surgery successfully. The operation time was 60 to 150 minutes with an average of 80 minutes. Arterial occlusion 10 ~ 30 min, an average of 20 min. Intraoperative blood loss of 100 ~ 800 ml, an average of 200 ml, 1 case of early bleeding the night after surgery, open surgery and repair success; 2 cases of postoperative suture hemorrhage, embolization satisfied; 3 cases 1 to 2 weeks after the pseudoaneurysm Tumor, embolization embolization satisfied; no leakage of urine occurred. The remaining recovered smoothly, hospitalized 7 to 10 days, an average of 8 days, followed up for 6 to 56 months, no tumor recurrence. Conclusion: Retroperitoneal nephrectomy with less trauma and faster recovery after operation is obviously superior to open surgery and is worth promoting. However, we should pay attention to the training of basic skills and strictly control the indications.