【摘要】：目的探討后腹腔鏡下腎部分切除術(shù)(RLPN)個(gè)體化方案治療小腎癌的可行性、安全性。方法回顧性分析2012年6月-2016年6月收治的98例實(shí)行RLPN治療的小腎癌患者,男57例,女41例,年齡28~75歲,平均52歲,腫瘤位于左腎46例,右腎52例,直徑0.8~4.5 cm,平均3.1 cm。87例(A組)小腎癌采用標(biāo)準(zhǔn)阻斷腎動(dòng)脈的狀態(tài)下實(shí)施腎部分切除;7例(B組)外突性生長(zhǎng)的小腎癌采用術(shù)中游離腎動(dòng)脈,套橡皮條備用,試行不阻斷腎動(dòng)脈零缺血的狀態(tài)下實(shí)施腎部分切除;4例(C組)影像學(xué)檢查提示內(nèi)生性小腎癌,采用腔內(nèi)超聲術(shù)中精確探查定位腎動(dòng)脈阻斷下實(shí)施腎部分切除。從術(shù)中情況、術(shù)后隨訪結(jié)果等分析其可行性、安全性。結(jié)果 A組87例中2例轉(zhuǎn)開放手術(shù),1例切緣陽(yáng)性,改腹腔鏡下腎根治性切除術(shù),術(shù)中出血量30~350 ml,平均93 ml,手術(shù)時(shí)間70~245 min,平均127 min,術(shù)中熱缺血時(shí)間20~42 min,平均26 min。B組7例外突性生長(zhǎng)的腎癌,6例未阻斷腎動(dòng)脈,1例出血明顯,切除腫瘤過程中,再阻斷腎動(dòng)脈15 min,完成腎部分切除術(shù),出血量160~380 ml,平均220 ml,手術(shù)時(shí)間85~215 min,平均143 min。C組4例中內(nèi)生性小腎癌全部手術(shù)過程順利,出血量35~250 ml,平均85 ml,手術(shù)時(shí)間110~235 min,平均175 min,術(shù)中熱缺血時(shí)間25~40 min,平均28 min。隨訪6~48個(gè)月,中位時(shí)間26個(gè)月,1例(腎門處3.0 cm透明細(xì)胞癌)術(shù)后18個(gè)月發(fā)現(xiàn)局部復(fù)發(fā)及肺部轉(zhuǎn)移,予索拉非尼分子靶向治療。結(jié)論 RLPN個(gè)體化方案治療小腎癌安全、有效,但尚需增加例數(shù)和長(zhǎng)期隨訪觀察明確其遠(yuǎn)期療效。
[Abstract]:Objective to investigate the feasibility and safety of (RLPN) individualized regimen in the treatment of small renal cell carcinoma (RCC) by retroperitoneal laparoscopic partial nephrectomy. Methods A retrospective analysis of 98 patients with small renal cell carcinoma treated with RLPN from June 2012 to June 2016 was performed. There were 57 males and 41 females, aged 2875 years (mean 52 years). 46 patients were located in the left kidney, 52 patients were in the right kidney, and the diameter was 0.84.5 cm,. The average of 3. 1 cm.87 patients (group A) underwent partial nephrectomy with standard occlusion of renal artery. 7 cases (group B) of small renal carcinoma with exophthalmic growth were treated with free renal artery and rubber strip during operation. Partial nephrectomy was carried out without occlusion of renal artery with zero ischemia. Imaging examination of 4 cases (group C) showed that endogenetic small renal cell carcinoma was resected by intraoperative accurate exploration and location of renal artery occlusion. The feasibility and safety were analyzed from the intraoperative and postoperative follow-up results. Results in group A, 2 cases were converted to open operation, 1 case was positive in incisal margin. Laparoscopic radical nephrectomy was performed with 30 ~ 350 ml, of blood loss. The average operative time was 93 ml,. The mean time of hot ischemia was 2042 min, during operation of 70,245 min, and 127 min,. In the 26 min.B group, there were 7 cases of renal carcinoma with sudden growth, 6 cases were not blocked renal artery, and 1 case had obvious bleeding. During the resection of tumor, partial nephrectomy was completed by reblocking the renal artery for 15 min, and the average amount of bleeding was 220 ml, (160 ~ 380 ml,). The operation time was 85 ~ 215 min, mean 143 min.C group, 4 cases of small renal cell carcinoma of endogenetic type were successfully operated, the mean operation time of bleeding was 35 ~ 250 ml, 85 ml, mean operation time was 110 ~ 235 min, 175 min, the mean time of hot ischemia was 2540 min, and the average time of 28 min. was 28 min.. Follow up for 6 ~ 48 months, median time 26 months, 1 case (3. 0 cm clear cell carcinoma of renal hilum) found local recurrence and pulmonary metastasis 18 months after operation, and was treated with Solafenib molecular targeted therapy. Conclusion RLPN individualized regimen is safe and effective in the treatment of small renal cell carcinoma.
【作者單位】： 浙江省湖州市第一人民醫(yī)院(湖州師范學(xué)院附屬第一醫(yī)院)泌尿外科;
【分類號(hào)】：R737.11

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