【摘要】：目的:探討后腹腔鏡聯(lián)合經(jīng)腰小切口"雜交"手術(shù)在復(fù)雜腎腫瘤保留腎單位手術(shù)中的臨床療效和安全性。方法:回顧性分析2015年4月至2016年12月在北京大學(xué)人民醫(yī)院泌尿外科進(jìn)行"雜交"保留腎單位手術(shù)的復(fù)雜腎腫瘤患者的臨床資料,其中男性10例,女性6例,年齡(50.2±10.7)歲,腫瘤位于左側(cè)9例,右側(cè)7例,腫瘤直徑(6.1±1.0)cm,R.E.N.A.L.評(píng)分平均(9.3±1.3)分�；颊呔捎煤蟾骨荤R聯(lián)合經(jīng)腰小切口的"雜交"手術(shù)方式進(jìn)行保留腎單位手術(shù),即在后腹腔鏡下完全游離腎和腎蒂血管,預(yù)置腎動(dòng)脈,然后取12肋下長約10~12 cm的切口進(jìn)行開放手術(shù),阻斷腎動(dòng)脈,直視下切除腫瘤、縫合創(chuàng)面。記錄手術(shù)時(shí)間、腎缺血時(shí)間、術(shù)中出血量、術(shù)后并發(fā)癥等圍手術(shù)期資料以及術(shù)后腎功能隨訪情況。結(jié)果:16例均全部成功完成手術(shù)。手術(shù)時(shí)間(164.9±23.6)min,腎缺血時(shí)間(32.4±6.2)min,術(shù)中出血量(204.0±125.1)m L,引流管拔除時(shí)間(4.1±1.0)d,術(shù)后平均住院時(shí)間(6.9±1.5)d。術(shù)后發(fā)生ClavienⅢ級(jí)以上并發(fā)癥2例:1例集合系統(tǒng)損傷;1例患者因術(shù)后出血,再次急診手術(shù)探查止血。術(shù)后第1天平均血肌酐水平為(126.3±26.4)μmol/L,與術(shù)前(74.3±16.9)μmol/L比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后1個(gè)月平均血肌酐水平為(92.6±18.2)μmol/L、術(shù)后3個(gè)月平均血肌酐水平為(80.8±18.4)μmol/L,與術(shù)前比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。隨訪3~20個(gè)月,均未見腫瘤復(fù)發(fā)和轉(zhuǎn)移。結(jié)論:后腹腔鏡聯(lián)合經(jīng)腰小切口"雜交"保留腎單位手術(shù)能夠降低手術(shù)難度,提高手術(shù)安全性,適用于部分經(jīng)過選擇的復(fù)雜腎腫瘤患者,有一定的臨床推廣價(jià)值。
[Abstract]:Objective: to evaluate the clinical efficacy and safety of retroperitoneal laparoscopy combined with translumbar small incision hybridization in complicated renal tumor nephron sparing surgery. Methods: the clinical data of patients with complicated renal tumors undergoing "hybrid" nephron-sparing surgery in the Department of Urology, people's Hospital of Peking University from April 2015 to December 2016 were retrospectively analyzed, including 10 males and 6 females, aged (50.2 鹵10.7) years. The tumor was located on the left in 9 cases and on the right in 7 cases. The diameter of the tumor was (6.1 鹵1.0) cm,R.E.N.A.L.. The average score was (9.3 鹵1.3). Retroperitoneal laparoscopy combined with "hybridization" through a small lumbar incision was used to perform nephron-sparing surgery, in which the renal artery was prepositioned by completely dissociating the kidney and renal pedicle vessels under retroperitoneal laparoscopy. Then the 12 subcostal incision, about 10 ~ 12 cm long, was opened to block the renal artery, the tumor was removed directly and the wound was sutured. The perioperative data such as operative time, renal ischemia time, intraoperative bleeding volume, postoperative complications and follow-up of postoperative renal function were recorded. Results: all the 16 cases were successfully operated. The operative time was (164.9 鹵23.6) min, the mean time of renal ischemia was (32.4 鹵6.2) min, the time of extubation of drainage tube was (204.0 鹵125.1) m L, the average time of hospitalization was (6.9 鹵1.5) days. There were 2 cases of complications above grade 鈪，

本文編號(hào)：2266998