摘要目的 评估经腰小切口保留肾单位手术(NSS)处理完全内生型肾肿瘤的可行性及安全性.方法 自2013年5月-2015年4月期间,共24例患者在上海中山医院行经腰小切口NSS治疗完全内生型肾肿瘤.回顾性分析患者术前病史、影像学、实验室检查结果、手术时间、缺血时间、术中出血量、术后并发症、手术前后肾功能改变及病理诊断以及长期(≥12个月)随访结果.结果 24例患者均结合术中B超定位完成手术,术后病理提示切缘均阴性.平均癌灶最大径为(3.3±0.6)cm;平均手术时间为(113 ±16) min;平均肾蒂阻断时间为(31 ±6) min;平均术中失血量为(102±46) ml;平均术后住院天数为(5.0±0.8)d;术前、术后血肌酐平均水平分别为(77.1±20.1)μ.mol/L和(90.3 ±20.0)μmol/L;术后长期随访未发现局部复发及远处转移.结论 经腰小切口行NSS治疗完全内生型肾肿瘤是一个安全可行的术式;结合术中超声可最大程度避免术中肿瘤包膜破裂;小切口有利于患者早期康复,具有独特优势.

abstractsObjective To investigate the safety and feasibility of mini-flank open nephron sparing surgery (MI-OPN) via retroperitoneal route for the treatment of centrally located renal tumor.Methods From May 2013 to April 2015,twenty-four cases of centrally located renal tumor were treated with MI-OPN via retroperitoneal route in Zhongshan Hospital.All cases were included in this study with whose clinical data and long term follow-up information retrospectively analyzed.Results With the assistance of intraoperative ultrasonography to confirm tumor location and boundary,MI-OPN was successfully performed in all cases.Mean tumor maximum diameter was 3.3 ± 0.6 cm,mean operation time was 113 ± 16 minutes,mean ischemia time was 31 ± 6 min,and mean estimated blood loss was 102 ± 46 ml.Mean postoperative hospital stay was 5.0 ± 0.8 days,postoperative complication was found in one patient (4％).The mean preand postoperative serum creatinine were 77.1 ± 20.1 μmol/L and 90.3 ± 20.0 μmol/L.Pathological examination confirmed negative surgical margin in all cases,with 18 cases of clear cell renal cell carcinoma,2 cases of papillary renal cell carcinoma,2 cases of chromophobe renal carcinoma,1 case of renal oncocytoma and 1 case of renal angiomyolipoma.In up to 12-36 months postoperative follow-up,no local recurrence or systemic progression was witnessed.Conclusions For the treatment of centrally localized renal tumor,MI-OPN via retroperitoneal route is a safe and feasible operation method.Importantly,rupture of the tumor capsule was effectively avoided during tumor resection with the assistance of ultrasonic positionsetting.Furthermore,incidence of severe postoperative complications such as bleeding and damage of collection system were not found since surgical wound of kidney sewn tightly and finely.The last but not the least,by placing ice slush in retroperitoneal cavity,impairment of renal function caused by renal artery clamping can be alleviated due to decreased metabolism.