發(fā)布時(shí)間：2018-06-08 18:21

  本文選題：早期腎腫瘤 + 后腹腔鏡��； 參考：《南昌大學(xué)》2017年碩士論文

【摘要】：目的:為了探討經(jīng)后腹腔入路腹腔鏡腎部分切除術(shù)治療的早期腎腫瘤并發(fā)癥,評(píng)價(jià)該術(shù)式的安全性及療效,為臨床治療早期腎腫瘤術(shù)式的選擇提供參考資料和方法:收集中國(guó)人民解放軍第175醫(yī)院泌尿外科2014年2月~2016年6月期間收住院22例早期腎腫瘤患者行后腹腔鏡下腎部分切除術(shù)(RLPN)治療臨床資料,男性16例,女性6例,平均年齡約44.2(25~62)歲;其腫瘤大小0.4cm~1.7cm×2.6cm~5.5 cm,平均約1.1cm×3.7cm。所有患者術(shù)前均行增強(qiáng)CT明確診斷,部分患者根據(jù)血肌酐水平行ECT檢查,并測(cè)量瘤體最大直徑。嚴(yán)格按照納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)篩選病例,記錄手術(shù)時(shí)間、失血量、輸血率、熱缺血時(shí)間、術(shù)中相關(guān)并發(fā)癥、圍手術(shù)期情況、術(shù)后并發(fā)癥、隨訪腎功能恢復(fù)和生存期情況等觀察指標(biāo),評(píng)價(jià)RLPN治療早期腎腫瘤的安全性和療效。結(jié)果:(1)手術(shù)情況:均順利完成手術(shù),無(wú)1例中轉(zhuǎn)開(kāi)放手術(shù)。手術(shù)時(shí)間90~152min,平均117.3min,熱缺血時(shí)間20~38min,平均28.5min;術(shù)中出血量200~400ml,平均267.7ml,術(shù)中輸血1例;術(shù)后導(dǎo)尿管、引流管均成功拔除;(2)術(shù)后病理學(xué)檢查結(jié)果:透明細(xì)胞癌14例(腫瘤表面脂肪組織受浸潤(rùn)1例、腫瘤細(xì)胞浸潤(rùn)包膜2例);腎血管平滑肌脂肪瘤5例;乳頭狀腎細(xì)胞癌3例;術(shù)中假包膜破裂1例。(3)隨訪情況:出院后獲隨訪19例,隨訪時(shí)間3~20個(gè)月,平均11個(gè)月;失訪3例。住院術(shù)后第3天腎功能恢復(fù)正常15例,隨后半年至1年期間,腎功能不全2例。肺部轉(zhuǎn)移1例,無(wú)死亡報(bào)道。(4)并發(fā)癥情況:后腹膜破裂3例;腎血管牽拉傷1例;松解血管夾后少量滲血3例。術(shù)后所有患者均述切口痛影響睡眠;皮下氣腫3例。肺部感染2例。結(jié)論:1采用經(jīng)腹膜后入路行腹腔鏡腎部分切除術(shù)治療早期腎腫瘤,具有解剖游離迅速,耗時(shí)更短、對(duì)胃腸道功能干擾輕等優(yōu)點(diǎn)。2確保手術(shù)療效的同時(shí),并未增加術(shù)中術(shù)后出血、術(shù)后漏尿、腎功能不全、腎周組織副損傷等并發(fā)癥發(fā)生率,進(jìn)一步證實(shí)經(jīng)腹膜后入路行腹腔鏡腎部分切除術(shù)治療早期腎腫瘤是安全有效的術(shù)式。
[Abstract]:Objective: to evaluate the safety and efficacy of laparoscopic partial nephrectomy in the treatment of early renal tumor complications. To provide references and methods for the selection of surgical procedures for early renal neoplasms: from February 2014 to June 2016, 22 patients with early renal neoplasms received retroperitoneal laparoscopy in the Urology Department of the 175th Hospital of the Chinese people's Liberation Army (PLA) from February 2014 to June 2016. Clinical data of partial nephrectomy with RLPN There were 16 males and 6 females, with an average age of 44.2 / 25 (62) years, and the tumor size was about 0.4cm~1.7cm 脳 2.6cm~5.5 cm, with an average of 1.1cm 脳 3.7 cm. All patients were diagnosed by enhanced CT before operation, and some patients were examined by ECT according to serum creatinine level, and the maximum diameter of tumor was measured. Select cases according to inclusion criteria and exclusion criteria strictly, record the operation time, blood loss, blood transfusion rate, hot ischemia time, intraoperative complications, perioperative conditions, postoperative complications, To evaluate the safety and efficacy of RLPN in the treatment of early renal tumors. Results: the operation was completed successfully, and no one was transferred to open operation. The mean operation time was 117.3 min, the mean time of operation was 117.3 min, the mean time of hot ischemia was 20 min (28.5 min), the volume of blood loss during operation was 200,400 ml (mean 267.7 ml), the intraoperative transfusion was 1 case, the postoperative urethral catheter, The results of pathological examination were as follows: 14 cases of clear cell carcinoma (1 case of infiltration of tumor surface adipose tissue, 2 cases of tumor cell infiltrating capsule), 5 cases of renal angiomyolipoma, 3 cases of papillary renal cell carcinoma, 5 cases of renal angiomyolipoma, 3 cases of papillary renal cell carcinoma, 5 cases of renal angiomyolipoma and 3 cases of papillary cell carcinoma. 1 case with false capsule rupture during operation: 19 cases were followed up after discharge, the average follow-up time was 11 months, 3 cases were lost. Renal function returned to normal in 15 cases on the 3rd day after hospitalization, and renal insufficiency occurred in 2 cases from 6 months to 1 year later. 1 case of pulmonary metastasis, no death report. 4) complications: 3 cases of posterior peritoneal rupture, 1 case of renal vascular pulling injury, 3 cases of small amount of blood leakage after decompression of blood vessels. All postoperative patients reported incision pain affecting sleep, 3 cases of subcutaneous emphysema. Pulmonary infection in 2 cases. Conclusion the retroperitoneal laparoscopic partial nephrectomy for early renal neoplasms has the advantages of rapid anatomic dissociation, shorter time consuming, less disturbance of gastrointestinal function, and so on, while ensuring the curative effect of the operation, and does not increase the intraoperative and postoperative bleeding at the same time. The incidence of complications such as leakage of urine, renal insufficiency, perirenal tissue injury and other complications further confirmed that laparoscopic partial nephrectomy via retroperitoneal approach is a safe and effective procedure for the treatment of early renal tumors.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.11

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本文編號(hào)：1996737