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后腹腔镜肾部分切除术个体化方案在小肾癌治疗中的应用

发布时间:2019-01-11 11:20  文章来源:笔耕文化传播
【摘要】:目的探讨后腹腔镜下肾部分切除术(RLPN)个体化方案治疗小肾癌的可行性、安全性。方法回顾性分析2012年6月-2016年6月收治的98例实行RLPN治疗的小肾癌患者,男57例,女41例,年龄28~75岁,平均52岁,肿瘤位于左肾46例,右肾52例,直径0.8~4.5 cm,平均3.1 cm。87例(A组)小肾癌采用标准阻断肾动脉的状态下实施肾部分切除;7例(B组)外突性生长的小肾癌采用术中游离肾动脉,套橡皮条备用,试行不阻断肾动脉零缺血的状态下实施肾部分切除;4例(C组)影像学检查提示内生性小肾癌,采用腔内超声术中精确探查定位肾动脉阻断下实施肾部分切除。从术中情况、术后随访结果等分析其可行性、安全性。结果 A组87例中2例转开放手术,1例切缘阳性,改腹腔镜下肾根治性切除术,术中出血量30~350 ml,平均93 ml,手术时间70~245 min,平均127 min,术中热缺血时间20~42 min,平均26 min。B组7例外突性生长的肾癌,6例未阻断肾动脉,1例出血明显,切除肿瘤过程中,再阻断肾动脉15 min,完成肾部分切除术,出血量160~380 ml,平均220 ml,手术时间85~215 min,平均143 min。C组4例中内生性小肾癌全部手术过程顺利,出血量35~250 ml,平均85 ml,手术时间110~235 min,平均175 min,术中热缺血时间25~40 min,平均28 min。随访6~48个月,中位时间26个月,1例(肾门处3.0 cm透明细胞癌)术后18个月发现局部复发及肺部转移,予索拉非尼分子靶向治疗。结论 RLPN个体化方案治疗小肾癌安全、有效,但尚需增加例数和长期随访观察明确其远期疗效。
[Abstract]:Objective to investigate the feasibility and safety of (RLPN) individualized regimen in the treatment of small renal cell carcinoma (RCC) by retroperitoneal laparoscopic partial nephrectomy. Methods A retrospective analysis of 98 patients with small renal cell carcinoma treated with RLPN from June 2012 to June 2016 was performed. There were 57 males and 41 females, aged 2875 years (mean 52 years). 46 patients were located in the left kidney, 52 patients were in the right kidney, and the diameter was 0.84.5 cm,. The average of 3. 1 cm.87 patients (group A) underwent partial nephrectomy with standard occlusion of renal artery. 7 cases (group B) of small renal carcinoma with exophthalmic growth were treated with free renal artery and rubber strip during operation. Partial nephrectomy was carried out without occlusion of renal artery with zero ischemia. Imaging examination of 4 cases (group C) showed that endogenetic small renal cell carcinoma was resected by intraoperative accurate exploration and location of renal artery occlusion. The feasibility and safety were analyzed from the intraoperative and postoperative follow-up results. Results in group A, 2 cases were converted to open operation, 1 case was positive in incisal margin. Laparoscopic radical nephrectomy was performed with 30 ~ 350 ml, of blood loss. The average operative time was 93 ml,. The mean time of hot ischemia was 2042 min, during operation of 70,245 min, and 127 min,. In the 26 min.B group, there were 7 cases of renal carcinoma with sudden growth, 6 cases were not blocked renal artery, and 1 case had obvious bleeding. During the resection of tumor, partial nephrectomy was completed by reblocking the renal artery for 15 min, and the average amount of bleeding was 220 ml, (160 ~ 380 ml,). The operation time was 85 ~ 215 min, mean 143 min.C group, 4 cases of small renal cell carcinoma of endogenetic type were successfully operated, the mean operation time of bleeding was 35 ~ 250 ml, 85 ml, mean operation time was 110 ~ 235 min, 175 min, the mean time of hot ischemia was 2540 min, and the average time of 28 min. was 28 min.. Follow up for 6 ~ 48 months, median time 26 months, 1 case (3. 0 cm clear cell carcinoma of renal hilum) found local recurrence and pulmonary metastasis 18 months after operation, and was treated with Solafenib molecular targeted therapy. Conclusion RLPN individualized regimen is safe and effective in the treatment of small renal cell carcinoma.
【作者单位】: 浙江省湖州市第一人民医院(湖州师范学院附属第一医院)泌尿外科;
【分类号】:R737.11

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