Janetschek G, Jeschke K, Peschel R, Strohmeyer D, Henning K, Bartsch G
Department of Urology, University of Innsbruck, Austria.
Eur Urol. 2000 Aug;38(2):131-8. doi: 10.1159/000020269.
Renal cell carcinoma (RCC) is likely to become one of the most important indications for laparoscopic surgery. We herein report our experience.
From April 1994 until April 1999, 98 patients presenting with RCC were treated laparoscopically by either radical nephrectomy (RN; n = 73) or wedge resection (WR; n = 25). The mean age was 62.3 years. The mean tumour diameters were 3.8 cm (RN) and 1.9 cm (WR). All tumours were clinical stage T1 lesions. The transperitoneal approach was used for RN in all patients. For WR either the transperitoneal or the retroperitoneal approach was used. In 15 patients, the adrenal gland was removed simultaneously. The specimen was entrapped in an organ bag and removed intact through a small muscle-splitting incision in the lower abdominal wall.
RN: The mean operating time was 142 (range 86-230) min, the mean blood loss was 170 (range 0-1,500) ml, and the mean postoperative hospital stay was 7.4 (range 3-32) days. Minor complications occurred in 4.0% of the patients, while major complications were seen in 8.0% of them. WR: The mean operating time was 163.5 (range 90-300) min, the mean blood loss was 287 (range 20-800) ml, and the postoperative hospital stay was 8.0 (range 3-8) days. Minor complications: 4%, major complications: 8%. Histology revealed RCC stage T1 in 77 patients, stage T3a in 7, and stage T3b in 3 patients, oncocytoma in 2 patients, angiomyolipoma in 2, renal adenoma in 1, renal metastasis in 1, multilocular cysts in 4, and renal abscess in 1 patient. Over mean follow-up periods of 13.3 and 22.2 months for RN and WR, respectively, neither local recurrences nor metastases have been observed among patients with histologically confirmed RCC.
Laparoscopic surgery for clinical stage T1 RCC is safe and efficient. Excellent tumour control can be achieved. However, longer follow-up periods will be necessary to confirm these results.
肾细胞癌（RCC）可能会成为腹腔镜手术最重要的适应症之一。我们在此报告我们的经验。
从1994年4月至1999年4月，98例肾细胞癌患者接受了腹腔镜手术，其中73例行根治性肾切除术（RN），25例行楔形切除术（WR）。平均年龄为62.3岁。平均肿瘤直径分别为3.8 cm（RN）和1.9 cm（WR）。所有肿瘤均为临床T1期病变。所有患者的RN均采用经腹途径。WR则采用经腹或腹膜后途径。15例患者同时切除肾上腺。标本装入器官袋，通过下腹壁一个小的肌间隙切口完整取出。
RN：平均手术时间为142（86 - 230）分钟，平均失血量为170（0 - 1500）毫升，平均术后住院时间为7.4（3 - 32）天。4.0%的患者出现轻微并发症，8.0%的患者出现严重并发症。WR：平均手术时间为163.5（90 - 300）分钟，平均失血量为287（20 - 800）毫升，术后住院时间为8.0（3 - 8）天。轻微并发症：4%，严重并发症：8%。组织学检查显示，77例患者为RCC T1期，7例为T3a期，3例为T3b期，2例为嗜酸细胞瘤，2例为肾血管平滑肌脂肪瘤，1例为肾腺瘤，1例为肾转移瘤，4例为多房囊肿，1例为肾脓肿。RN和WR患者的平均随访期分别为13.3个月和22.2个月，在组织学确诊为RCC的患者中均未观察到局部复发或转移。
临床T1期RCC的腹腔镜手术安全有效。可实现良好的肿瘤控制。然而，需要更长的随访期来证实这些结果。
