吴齐全+任雨+姚许平+朱伟智+高文波+孙涛

[基金项目] 浙江省宁波市第四批科技项目（甬科计[2010]67号）

[摘要] 目的 对比中央型肾癌与外周型肾癌腹腔镜保留肾单位的手术特点。方法 行保留肾单位手术的肾癌患者64例，中央型肾癌15例和外周型肾癌49例。比较两种肺癌患者手术时间、阻断方式及时间、术中出血和术后并发症发生情况。 结果 15例中央型肾癌组患者手术顺利，平均手术时间(140.1±47.2)min，术中均采用选择性肾段动脉阻断，阻断时间(28.5±9.2)min，平均出血量为(170.3±40.3)mL，术后出现尿瘘2例，肾周血肿1例；49例外周型肾癌组患者手术顺利，平均手术时间(123.2±39.3)min，术中均采用单纯肾动脉完全阻断，阻断时间(19.3±6.2)min，平均出血量(139.5±35.1)mL，术后发生继发性出血1例，无尿瘘发生。 结论 术前准备细致和手术操作规范，保留肾单位手术对于中央型肾癌是安全可行的。

[关键词] 中央型肾癌；外周型肾癌；腹腔镜；肾部分切除术

[中图分类号] R699.2[文献标识码] B[文章编号] 1673-9701（2014）19-0157-04

The comparative study on laparoscopic partial nephrectomy for central and peripheral renal tumors

WU Qiquan REN Yu YAO Xuping ZHU Weizhi GAO Wenbo SUN Tao

Department of Urological Surgery，Ningbo Urology and Nephrology Hospital，Ningbo 315100，China

[Abstract] Objective To compare the operation characteristic and clinical experience of laparoscopic nephron sparing surgery for central and peripheral renal tumors. Methods A total of 64 cases of laparoscopic partial nephrectomies for renal tumors were divided into two groups:15 cases of laparoscopic partial nephrectomies for central type renal tumors and 49 cases of laparoscopic partial nephrectomies with peripheral type renal tumors. Operation time, blood vessel blocking time, intraoperative bleeding and postoperative complications of two groups are compared. Results For the patients with central renal tumors, mean operative time was (140.1±47.2) minutes. Mean ischemic time was (28.5±9.2) minutes. Mean blood loss was(170.3±40.3) mL．The major post-operative complication included leakage of urine(two cases ) and perirenal hematoma(one case). For the patients with peripheral based tumors, mean operative time was (123.2±39.3) minutes. Mean ischemic time was(19.3±6.2) minutes. Mean blood loss was(139.5±35.1)mL. The major postoperative complication included postoperative bleeding(one case). Conclusion Through careful preoperative preparation and standard operation technique , the nephron sparing surgery of centrally localized renal tumors is safe.

[Key words] Central renal tumors；Peripheral renal tumors；Laparoscope；Partial nephrectomy

随着影像技术的发展，临床工作中无症状小肾癌诊断率增长了1倍。外科肾脏根治性切除术是治疗肾癌的标准术式，但小肾癌或难以手术的肾癌则提倡保肾手术。小肾癌保留肾单位手术疗效与根治性肾切除术基本一致，被广泛用于小肾癌的治疗。腹腔镜肾部分切除术（laparoscopic partial nephrectomy, LPN）已成为治疗外周型肾癌的重要术式。中央型肾癌由于靠近肾脏主干血管和集合系统，手术难度相对较大。2008年2月～2012年12月我们对64例肾脏肿瘤患者行腹腔镜肾部分切除术，比较中央型肾癌与外周型肾癌的手术特点，分析中央型肾癌腹腔镜肾部分切除术的可行性。……