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目的:探讨后腹腔镜肾部分切除术治疗T1b期肾癌的临床疗效。方法:2008年3月~2012年10月我院行后腹腔镜肾部分切除术治疗17例T1b期肾癌患者,所有患者均为单侧肾肿瘤,对侧肾功能正常。其中男/女=9/8,左/右=7/10。所有患者TNM分期肾癌符合T1b N0M0(直径4.1~7.0cm)。患者年龄36~80(55.3±21.5)岁,肿瘤直径为4.1~5.7(4.6±0.4)cm。结果:所有手术均成功。手术时间103~210(160.2±36.2)min,肾动脉阻断时间14~35(23.1±7.3)min,术中估计出血量20~360(170.5±70.4)ml,术后住院天数4~13(8.7±3.4)d,患者术前血清肌酐为55~120(89.3±20.2)μmol/L,术后3天内血清肌酐为63~126(101.2±19.8)μmol/L。术后病理:透明细胞癌15例,乳头状肾细胞癌1例,粘液小管状梭形细胞癌1例。术后随访4~60(25.3±19.2)个月,所有患者均存活,无肾脏肿瘤的局部复发及远处转移,末次随访时患者血清肌酐为58~114(93.2±20.6)μmol/L。术中2例患者行集合系统修补,术后所有患者均无尿漏发生。1例患者出现肾周少量血肿,严格卧床后血肿逐渐吸收。结论:后腹腔镜肾部分切除手术治疗位置合适的T1b期肾癌患者安全有效,创伤小,恢复快,肿瘤中短期控制情况良好,但远期疗效尚待大规模随机对照研究及长期随访观察。
Objective: To investigate the clinical effect of retroperitoneal nephrectomy for T1b stage renal cell carcinoma. Methods: From March 2008 to October 2012, 17 cases of T1b renal cell carcinoma were treated by retroperitoneal laparoscopic partial nephrectomy in our hospital. All patients were with unilateral renal tumor and the contralateral kidney function was normal. Male / female = 9/8, left / right = 7/10. TNM staging of all patients with renal cell carcinoma T1b N0M0 (diameter 4.1 ~ 7.0cm). The patients were 36 to 80 years old (55.3 ± 21.5 years) and the tumor diameter was 4.1 to 5.7 (4.6 ± 0.4) cm. Results: All surgeries were successful. The operative time was 103-210 (160.2 ± 36.2) min and the renal artery occlusion time was 14-35 (23.1 ± 7.3) min. The intraoperative blood loss was estimated to be 20-360 (170.5 ± 70.4) ml and the postoperative hospital stay was 4-13 ( 8.7 ± 3.4) d. The preoperative serum creatinine was 55 ~ 120 (89.3 ± 20.2) μmol / L, and the serum creatinine was 63 ~ 126 (101.2 ± 19.8) μmol / L within 3 days after operation. Postoperative pathology: 15 cases of clear cell carcinoma, papillary renal cell carcinoma in 1 case, tubular mucinous tuberculoma in 1 case. The patients were followed up for 4 to 60 (25.3 ± 19.2) months. All patients survived without local recurrence and distant metastasis of renal tumors. Serum creatinine was 58 ~ 114 (93.2 ± 20.6) μmol / L at the final follow-up. Intraoperative 2 patients underwent a collection system repair, no postoperative urinary leakage occurred in all patients. One patient had a small amount of hematoma around the kidney, and the hematoma gradually absorbed after being in bed seriously. Conclusions: Retroperitoneal laparoscopic partial nephrectomy for patients with T1b stage renal cell carcinoma is safe and effective, with less trauma and rapid recovery. The short-term and long-term control of the neoplasms are good. However, long-term results are yet to be observed in large-scale randomized controlled trials and long-term follow-up.