[1]黄建林,安宇,廖勇*,等.后腹腔镜保留肾单位手术治疗70岁以上老年局限性肾癌[J].中国微创外科杂志,2017,17(08):748-751.
　Huang Jianlin,An Yu,Liao Yong,et al.Retroperitoneal Laparoscopic Nephronsparing Surgery for Localized Renal Cancer in the Elderly Over 70 Years Old[J].Chinese Journal of Minimally Invasive Surgery,2017,17(08):748-751.
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后腹腔镜保留肾单位手术治疗70岁以上老年局限性肾癌()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
17
期数:
2017年08期
页码:
748-751
栏目:
经验交流
出版日期:
2017-08-20

文章信息/Info

Title:
Retroperitoneal Laparoscopic Nephronsparing Surgery for Localized Renal Cancer in the Elderly Over 70 Years Old
作者:
黄建林; 安宇; 廖勇*; 刘竞; 罗一钊; 邱明星
四川省医学科学院·四川省人民医院泌尿外科，成都610072
Author(s):
Huang Jianlin;  An Yu;  Liao Yong;  et al.
Department of Urology, Sichuan Academy of Medical Science & Sichuan Provincial People’s Hospital, Chengdu 610072, China
关键词:
肾细胞癌; 老年人; 保留肾单位手术; 腹腔镜
Keywords:
Renal cancer; The elderly; Nephronsparing surgery; Laparoscopy
文献标志码:
B
摘要:
目的探讨后腹腔镜保留肾单位手术治疗70岁以上老年局限性肾癌的疗效。 方法2011年9月~2014年12月对16例70岁以上肾癌行后腹腔镜肾部分切除术。建立后腹腔气腹后分别置入3枚trocar，打开侧椎筋膜，在腰大肌与肾脂肪囊间分离，上至膈肌，下至输尿管。游离肾脏中部，找到肾动脉，找到并游离肿物，置入血管阻断钳夹闭肾动脉，剪刀距肿瘤边缘0.5 cm切除肿物及部分肾实质，30可吸收线缝合集合系统（肿瘤位置较深邻近集合系统者），以20倒刺线连续贯穿缝合肾实质，缝合完毕后以Hemolok夹固定。松开血管阻断钳，出血部分加强缝合。结果16例手术均成功完成，无中转开放。手术时间55~240 min，（132.4±46.4）min，血管阻断时间12~40 min，（25.3±7.6）min；术中出血量10~200 ml，（79.7±62.6）ml，无输血。术后住院时间6~15 d，(9.4±3.2)d。16例随访（30.8±9.5）月，1例术后24个月因全身肿瘤转移死亡，1例术后31个月因心脏疾病死亡，其余患者无复发、转移。1例术后18个月出现肾功能衰竭，规律行腹膜透析。 结论后腹腔镜保留肾单位手术治疗70岁以上老年局限性肾癌安全有效，条件允许时推荐采用。
Abstract:
ObjectiveTo evaluate the efficacy of retroperitoneal laparoscopic nephronsparing surgery in the treatment of elderly patients over 70 years old with localized renal cancer. MethodsSixteen elderly patients with renal cancer underwent laparoscopic partial nephrectomy in our hospital from September 2011 to December 2014. During the surgery, 3 trocars were placed respectively after retroperitoneum pneumoperitoneum had been established. While the lateral conal fascia was opened, separating was performed between the lumbar major muscle and fatty renal capsule, up to the diaphragm and down to the ipsilateral ureter. The renal artery was exposed from the central part of the kidney, and the mass was found and dissociated from circumambient fat. A nontraumatic vascular clamp was placed to occlude renal artery temporarily, and the tumor and partial renal parenchyma were resected away from the tumor edge 0.5 cm with scissors. The collection system was closed with a 30 absorbable suture when the tumor was located deeply and adjacent to the collection system, and the renal parenchyma wound was closed continuously with 20 barbed sutures, which was immobilized with a Hemolok clip after the suture completed. The bleeding section was reinforced with added sutures after the vascular clamp released.ResultsAll the operations in 16 cases were successfully completed without transferring to open surgery. The operation time was (132.4±46.4) min, ranged 55-240 min. The warm ischemia time (WIT) was (25.3±7.6) min, ranged 12-40 minutes. The mean estimated blood loss during surgery was (79.7±62.6) ml, ranged 10-200 ml. No patient received blood transfusion. The postoperative hospital stay was (9.4±3.2) d, ranged 6-15 d. The average followup time was (30.8±95) months. One patient died of tumor metastasis 24 months after surgery, and another one died of heart disease after 31 months after surgery. The remaining patients survived without recurrence or metastasis. One patient needed regular peritoneal dialysis because of renal failure occurred at 18 months after operation.ConclusionRetroperitoneal laparoscopic nephronsparing surgery is a safe and effective approach in the treatment of elderly patients over 70 years old with localized renal cancer，which can be recommended if necessary.

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备注/Memo

备注/Memo:
*通讯作者，Email: liaoyong616@sina.com
更新日期/Last Update: 2017-11-22