Abstract：Objective: To evaluate the safety and efficacy of modified retroperitoneal laparoscopic nephron sparing surgery for localized renal carcinoma of inferior pole. Methods: A retrospective analysis was performed on 9 patients who underwent modified retroperitoneal laparoscopic nephron sparing surgery for localized renal carcinoma of inferior pole in our unit from Mar. 2017 to Nov. 2018. The indexes of warm ischemia time, bleeding during operation, the creatinine before and after operation, complications and positive rate of cutting edge were analyzed. Results: All 9 patients were not transferred to open surgery. The warm ischemia time ranged from 11 to 23 min (16.4 ± 3.0 min). Blood loss was 40 to 100 mL (73.9 ± 18.7 mL) during operation. The serum creatinine was (94.57 ± 16.14) μmol/L before operation, (100.16 ± 17.13) μmol/L immediately after operation, (89.67 ± 16.83) μmol/L 48 h after operation, (91.78 ± 14.89) μmol/L at discharge. There was no significant difference in creatinine at different time points (P > 0.05). Pathological margins were negative. No complications such as secondary bleeding, infection and urinary fistula occurred after operation. Conclusion: The modified retroperitoneal laparoscopic partial nephrectomy for localized renal tumors of inferior pole can shorten the time of warm ischemia, ensure the quality of suture, and minimize the occurrence of complications such as urinary fistula, secondary hemorrhage and post-abdominal infection.
赵豫波, 刘萃龙, 王希友, 王毅, 张新宇, 谢常亮, 陈伟浩. 改良后腹腔镜保留肾单位手术治疗局限性肾下极肿瘤的临床探讨[J]. 微创泌尿外科杂志, 2020, 9(4): 221-225.
ZHAO Yubo, LIU Cuilong, WANG Xiyou, WANG Yi, ZHANG Xinyu, XIE Changliang, CHEN Weihao. Modified retroperitoneal laparoscopic nephron sparing surgery in the treatment of renal carcinoma of inferior pole. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2020, 9(4): 221-225.
[1] 吴阶平. 吴阶平泌尿外科学.济南:山东科学技术出版社,2005:889-917.
[2] 韩苏军,王栋,李长岭,等.1998-2008年中国肾癌发病趋势分析.癌症进展,2018,16(10):1234-1237.
[3] EDGE SB, BYRD DR, COMPTON CC, et al. AJCC cancer staging manual.7th ed. New York: Springer-Verlag,2009:547-560.
[4] 那彦群,叶章群,孙光,等.中国泌尿外科疾病诊断治疗指南.北京:人民卫生出版社,2013:6-7.
[5] 祝敏,宋秘,张长升,等.后腹腔镜保留肾单位手术治疗局限性肾癌相关技术的研究进展.山东医药,2018,58(5):106-109.
[6] 马潞林. 泌尿外科微创手术学.第2版.北京:人民卫生出版社,2013:120.
[7] 张旭. 泌尿外科腹腔镜手术学.北京:人民卫生出版社,2008:81.
[8] 曾晓明,雷弋,张天德,等.68例后腹腔镜肾部分切除术治疗肾脏肿瘤的临床疗效分析.临床泌尿外科杂志,2016,31(5):431-433.
[9] 肖建军,周晓晨,张亿达,等.不阻断肾蒂机器人辅助腹腔镜肾部分切除术初步体会.现代泌尿外科杂志,2018,23(8):613-616.
[10] THOMPSON RH, LANE BR, LOHSE CM, et al. Every minute counts when the renal hilum is clamped during partial nephrectomy. Eur Urol, 2010,58(3):340-345.
[11] LAVEN B, ORVIETO MA, CHUANG MS, et al. Renal tolerance to prolonged warm ischemia time in a laparoscopic versus open surgery porcine model. J Urol, 2004,172(6Pt1):2471-2474.
[12] KHENE ZE, PEYRONNET B, MATHIEU R, et al. Analysis of the impact of adherent perirenal fat on peri-operative outcomes of robotic partial nephrectomy. World J Urol, 2015,33(11):1801-1806.
[13] 李松,常泰浩,张瑞珊,等.肾周脂肪对微创肾部分切除术影响的新认识.微创泌尿外科杂志,2018,7(2):135-140.
[14] 郭瑞宾. 后腹腔镜泌尿外科手术致后腹膜腔感染病因探讨.基层医学论坛,2016,20(19):2742-2743.
