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目的总结肾部分切除术治疗T1期肾癌的手术方式和临床疗效。方法回顾性分析20例行肾部分切除术的T1期肾癌患者的临床资料,男11例,女9例,平均年龄44岁。20例中双侧肾癌1例,孤立肾肾癌2例,对侧肾有病变或有潜在功能受损的肾癌6例,对侧肾功能正常的肾癌11例。肿瘤平均直径3.8cm。开放手术行肾部分切除术14例,后腹腔镜肾部分切除术6例,其中行选择性肾段动脉阻断的肾部分切除术2例。结果手术均顺利完成,平均出血80ml,平均手术时间160min。平均肾动脉及肾段动脉阻断时间28min。术后病理均为肾透明细胞癌。18例患者获访3～36个月,平均18个月,无外科并发症,无肿瘤局部复发及远处转移。术后出现暂时性肾功能不全2例,肾萎缩1例。结论肾部分切除术治疗早期肾癌安全有效,后腹腔镜肾部分切除术与开放手术比较,除术中出血稍多和手术时间稍长外,肿瘤的控制和并发症无显著差异。后腹腔镜选择性肾段动脉阻断的肾部分切除术在肾功能保留方面有一定优势。
Objective To summarize the surgical approach and clinical effect of partial nephrectomy for T1 stage renal cell carcinoma. Methods The clinical data of 20 patients with T1 stage renal cell carcinoma undergoing partial nephrectomy were retrospectively analyzed. There were 11 males and 9 females, with an average age of 44 years. 20 cases of bilateral renal cell carcinoma in 1 case, isolated renal cell carcinoma in 2 cases, contralateral kidney lesions or potentially impaired renal cell carcinoma in 6 cases, contralateral kidney function in normal renal cell carcinoma in 11 cases. The average tumor diameter 3.8cm. There were 14 cases of partial nephrectomy and 6 cases of retroperitoneal laparoscopic nephrectomy. Among them, partial nephrectomy with selective renal artery occlusion was performed in 2 cases. Results The operation was successfully completed, the average bleeding 80ml, the average operation time 160min. The average renal artery and renal artery occlusion time 28min. Postoperative pathology were renal clear cell carcinoma. Eighteen patients were followed up for 3 to 36 months with an average of 18 months. There were no surgical complications, no local tumor recurrence and distant metastasis. Postoperative transient renal insufficiency in 2 cases, 1 case of renal atrophy. Conclusions Partial nephrectomy is safe and effective for the treatment of early stage renal cell carcinoma. There is no significant difference in the control and complications of laparoscopic nephrectomy compared with open surgery. Retroperitoneal partial nephrectomy with segmental renal artery blockade has some advantages in renal function preservation.