|本期目录/Table of Contents|

[1]吴海严,徐锋,郑鹏,等.后腹腔镜下保留肾单位肾肿瘤切除术治疗早期肾癌的不同方法分析[J].医学研究与战创伤救治(原医学研究生学报),2018,20(02):113-117.[doi:10.3969/j.issn.1672-271X.2018.02.001]
　WU Hai-yan,XU Feng,ZHENG Peng,et al.Analysis of different surgical treatments of retroperitoneal laparoscopic partial nephrectomy for patients with localized renal cell carcinoma[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2018,20(02):113-117.[doi:10.3969/j.issn.1672-271X.2018.02.001]
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后腹腔镜下保留肾单位肾肿瘤切除术治疗早期肾癌的不同方法分析()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第20卷
期数:
2018年02期
页码:
113-117
栏目:
出版日期:
2018-03-20

文章信息/Info

Title:
Analysis of different surgical treatments of retroperitoneal laparoscopic partial nephrectomy for patients with localized renal cell carcinoma
作者:
吴海严; 徐锋; 郑鹏; 程文; 葛京平; 张征宇
作者单位：210002南京，南京大学医学院附属金陵医院（南京军区南京总医院）泌尿外科（吴海严、徐锋、郑鹏、程文、葛京平、张征宇）
Author(s):
WU Hai-yan; XU Feng; ZHENG Peng; CHENG Wen; GE Jing-ping; ZHANG Zheng-yu
(Department of Uroloy, Jinling Hospital, Nanjing University, School of Medicine/Nanjing General Hospital of Nanjing Military Region,PLA,Nanjing 210002,Jiangsu,China)
关键词:
后腹腔镜; 肾肿瘤切除术; 手术方法; 肾功能
Keywords:
retroperitoneal laparoscopy;  partial nephrectomy;  surgical treatment methods;  renal function
分类号:
R737.11
DOI:
10.3969/j.issn.1672-271X.2018.02.001
文献标志码:
A
摘要:
目的 观察分析后腹腔镜下保留肾单位肾肿瘤切除方法 的疗效及对患者术后肾功能的影响。 方法 回顾性分析2008年1月至2015年12月，南京军区南京总医院泌尿外科收治的80例肾癌患者临床资料，肿瘤最大直径≤4.0 cm（T1a期），并施行后腹腔镜下保留肾单位肾肿瘤切除术。按手术方法 将患者分为4组：A组（n=21）为单纯肾肿瘤剜除术，B组（n=18）为序贯法行肿瘤切除术，C组（n=21）为选择性肾段动脉阻断行肿瘤切除术，D组（n=20）为适时肾蒂或肾动脉阻断行肿瘤切除术。观察4组患者术前术后肾小球滤过率（GFR）的变化来判断各组患者术后肾功能的改变。结果 施行后腹腔镜下保留肾单位肾肿瘤切除术的80例患者均手术成功，无一例中转开放手术。其中D组有11例患者术中阻断肾动脉，平均阻断时间（11.5±2.5）min，且患者R.E.N.A.L.评分均≥7分。术后标本切缘病理检测均为阴性，术前术后GFR的差异无统计学意义（P>0.05）。术后平均随访（22.0±15.8）个月，除1例患者随访中发现对侧肾肿瘤生长（发生率1.25%），其余患者术后情况良好。结论 4种后腹腔镜下保留肾单位肾肿瘤切除术治疗T1a期肾癌安全有效，能完成绝大部分肾肿瘤的切除，并且能最大限度地保护术后患肾功能。
Abstract:
Objective To observe the efficacy of 4 different surgical treatments of retroperitoneal laparoscopic nephron sparing surgery for patients with localized renal cell carcinoma and its effects for the postoperative renal function. Methods From January 2005 to December 2015, 80 cases of patients with renal tumor which diameter was 4cm or less received retroperitoneal laparoscopic nephron sparing surgery. According to the surgical method, they were divided into 4 groups: simple enucleation (group A, n=21), sequential method (group B, n=18), selective segmental renal artery clamping (group C, n=21) and renal artery clamping on demand (group D, n=20). The changes of glomerular filtration rate before and after operation were observed in 4 groups to determine the change of renal function.Results All the procedures were completed successfully without conversion to open surgery. The mean ischemic time was (11.5±2.5) min of 11 cases in group D and Radius Exophytic Nearness Anterior Location scores (R.E.N.A.L.) were greater than 7. The surgical margin was negative in all cases and there was no statistically significant difference in glomerular filtration rate between before and after surgery (P＞0.05). The contralateral kidney tumor occurred in 1 case (1.25%) and the others were healthy during (22.0±15.8) months of follow-up. Conclusion The 4 different surgical treatments of retroperitoneal laparoscopic partial nephrectomy for localized renal cell carcinoma are safe and effective. It can treat the most of renal cell carcinoma and reserve the postoperative renal function maximally.

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备注/Memo

备注/Memo:
基金项目：国家自然科学基金（81572526）；南京军区南京总医院科研基金（2015011）
更新日期/Last Update: 2018-03-20