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目的:探讨一种完全不阻断肾动脉的腹腔镜肾部分切除术(LPN)的安全性、可行性和临床结果。方法:2014年6月~2014年12月我院为6例患者行完全不阻断肾动脉LPN。其中男4例,女2例,患者平均年龄54.5(38~79)岁。患者中位体重指数26.6(23.4~31.2)kg/m2。右侧肿瘤4例,左侧2例。肿瘤R.E.N.A.L.评分为4.3(4~5)分,平均肿瘤直径2.8(1.5~4.8)cm。术中在切除肿瘤之前,预先在肿瘤切除边缘的正常肾实质用带倒刺缝线进行缝合,适当力量吊起肾组织,以控制出血。在肿瘤与预先缝合之间用剪刀冷切除肿瘤。当肾部分切除创面出血时行创面肾实质缝合,重复此操作,直至完整切除肿瘤。最后完成肾创面缝合。结果:本组4例采用经腹途径完成,2例采用经后腹膜腔途径完成。所有患者均未阻断肾动脉,术中平均出血60.8(20~150)ml,平均手术时间106.7(65~130)min。无围手术期输血及严重并发症。平均术后住院时间4.3(2~6)d。术后病理4例为透明细胞癌,1例为复杂性肾囊肿,1例为肾错构瘤,外科切缘均为阴性。结论:完全不阻断肾动脉LPN对经选择的患者是一种安全有效的技术,该技术可以通过避免肾热缺血时间而保护肾功能。
Objective: To investigate the safety, feasibility and clinical outcome of a laparoscopic partial nephrectomy (LPN) that does not block the renal arteries completely. Methods: From June 2014 to December 2014, 6 patients in our hospital did not block renal artery LPN completely. Including 4 males and 2 females, the average age of patients 54.5 (38 ~ 79) years old. The median body mass index of patients 26.6 (23.4 ~ 31.2) kg / m2. Right side of the tumor in 4 cases, 2 cases left. The tumor R.E.N.A.L. score was 4.3 (4 to 5) points, with a mean tumor diameter of 2.8 (1.5-4.8) cm. Intraoperative prior to tumor resection, the tumor in advance of the edge of the normal renal parenchyma with suture suture suture, lifting the appropriate strength of kidney tissue to control bleeding. Cold-excision of the tumor with scissors between the tumor and the pre-suture. When the kidneys were partially resected, the wounds were sutured with the renal parenchyma, and the operation was repeated until the complete resection of the tumor. Finally, complete the kidney wound suture. Results: The group of 4 cases completed by the abdominal approach, 2 cases by the retroperitoneal approach. All patients did not block the renal artery, the average intraoperative bleeding 60.8 (20 ~ 150) ml, the average operation time was 106.7 (65 ~ 130) min. No perioperative blood transfusion and serious complications. The average postoperative hospital stay 4.3 (2 ~ 6) d. Postoperative pathology in 4 cases of clear cell carcinoma, 1 case of complex renal cysts, 1 case of renal hamartoma, surgical margin were negative. CONCLUSION: Complete non-blocking renal artery LPN is a safe and effective technique for selected patients, which protects renal function by avoiding renal warm ischemia.