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目的:通过病例对比分析,综合评价腹腔镜肾部分切除术的安全性和临床效果。方法:对我院泌尿外科在2011年1月-2013年1月接诊的80名经腹腔镜进行肾部分切除术的患者进行回顾性分析,其中男性患者58例,女性患者22例,平均年龄为48岁。对比80例患者的手术时间、出血量、术后并发症、住院时间、复发时间。结果:术后进行病理检查,确诊有58例肾透明细胞癌、有4例乳头状肾细胞癌、15例肾血管平滑肌脂肪瘤和3例嗜酸细胞瘤。术后尿漏者2例,未予特殊治疗1周后尿漏消失。肾周血肿者2例,CT显示血肿大小约3cm×2cm×2cm,予绝对卧床2周后复查CT已基本吸收。肾功能不全者2例,Cr为184μmol/L,肾肿瘤为6cm,位于上级腹侧,肾动脉3个分支,阻断时间40min,对侧肾为肾结石,术后随访3个月后肾功能正常。术后平均住院时间8(6-13)d。所有患者随访时间4-50个月,未见肿瘤复发。结论:腹腔镜肾部分切除术安全有效,但对手术适应症有一定限制,应选择突出于肾表面的局限性肿瘤。虽然该术式对操作技术要求较高,但肿瘤大小和位置仍是决定手术成败的主要因素。
OBJECTIVE: To evaluate the safety and clinical efficacy of laparoscopic partial nephrectomy by comparing the cases. Methods: A retrospective analysis was performed on 80 patients undergoing partial nephrectomy by laparoscopy from January 2011 to January 2013 in our urology department. Among them, 58 were male patients and 22 were female patients. The mean age 48 years old. The operation time, blood loss, postoperative complications, hospitalization time and recurrence time of 80 patients were compared. Results: Postoperative pathological examination confirmed 58 cases of renal clear cell carcinoma, 4 cases of papillary renal cell carcinoma, 15 cases of renal angiomyolipoma and 3 cases of oncocytoma. Postoperative urine leakage in 2 cases, without special treatment 1 week after the disappearance of urine leakage. Peritoneal hematoma in 2 cases, CT showed hematoma about 3cm × 2cm × 2cm, to the absolute bed for 2 weeks after the review CT has been basically absorbed. Renal insufficiency in 2 cases, Cr was 184μmol / L, renal tumor was 6cm, located in the superior ventral, renal artery 3 branches, blocking time 40min, contralateral kidney as kidney stones, 3 months after follow-up renal function normal. The average postoperative hospital stay 8 (6-13) d. All patients were followed up for 4-50 months, no tumor recurrence. Conclusion: Laparoscopic partial nephrectomy is safe and effective, but there are some limitations on the indications for surgery. Localized tumors that protrude from the surface of the kidney should be selected. Although the operation of the surgical technique requires higher, but the size and location of the tumor is still the main factor determining the success or failure of surgery.