Guillonneau B, Bermúdez H, Gholami S, El Fettouh H, Gupta R, Adorno Rosa J, Baumert H, Cathelineau X, Fromont G, Vallancien G
Department of Urology, Institut Mutualiste Montsouris, Paris, France.
J Urol. 2003 Feb;169(2):483-6. doi: 10.1097/01.ju.0000045225.64349.bf.
We performed a nonrandomized retrospective comparison of 2 techniques for laparoscopic partial nephrectomy, that is without and with clamping the renal vessels.
Between December 1997 and February 2002, 28 consecutive patients underwent transperitoneal laparoscopic partial nephrectomy for renal tumor. In group 1 (12 patients) partial nephrectomy was performed with ultrasonic shears and bipolar cautery without clamping the renal vessels, while in group 2 (16 patients) the renal pedicle was clamped before tumor excision. In group 2 patients intracorporeal kidney cooling was achieved by a ureteral catheter connected to 4C solution. Intracorporeal freehand suturing techniques were used to close the collecting system when opened and approximate the renal parenchyma.
All procedures were successfully completed laparoscopically. Mean renal ischemia time +/- SD was 27.3 +/- 7 minutes (range 15 to 47) in group 2 patients. Mean laparoscopic operating time was 179.1 +/- 86 minutes (range 90 to 390) in group 1 compared with 121.5 +/- 37 minutes (range 60 to 210) in group 2 (p = 0.004). Mean intraoperative blood loss was significantly higher in group 1 than in group 2 (708.3 +/- 569 versus 270.3 +/- 281 ml., p = 0.014). Three patients in group 1 and 2 in group 2 required blood transfusions. Immediately postoperatively mean creatinine was 1.26 +/- 0.36 and 1.45 +/- 0.61 mg./dl. in groups 1 and 2, respectively (p = 0.075). Surgical margins were negative in all specimens. Pathological examination revealed renal cell cancer in 18 cases (stages pT1 in 17 and pT3a in 1), oncocytoma in 4, angiomyolipoma in 5 and renal adenoma in 1.
Laparoscopic partial nephrectomy represents a feasible option for patients with small renal masses. Clamping the renal vessels during tumor resection and suturing the kidney mimics the open technique and seems to be associated with less blood loss and shorter laparoscopic operative time.
我们对两种腹腔镜部分肾切除术技术进行了非随机回顾性比较，即不阻断肾血管和阻断肾血管的技术。
1997年12月至2002年2月期间，28例连续患者因肾肿瘤接受经腹腹腔镜部分肾切除术。在第1组（12例患者）中，使用超声刀和双极电凝进行部分肾切除术，不阻断肾血管；而在第2组（16例患者）中，在肿瘤切除前阻断肾蒂。在第2组患者中，通过连接到4℃溶液的输尿管导管实现体内肾脏降温。当集合系统打开时，采用体内徒手缝合技术进行关闭，并使肾实质对合。
所有手术均通过腹腔镜成功完成。第2组患者的平均肾缺血时间±标准差为27.3±7分钟（范围15至47分钟）。第1组的平均腹腔镜手术时间为179.1±86分钟（范围90至390分钟），而第2组为121.5±37分钟（范围60至210分钟）（p = 0.004）。第1组的平均术中失血量显著高于第2组（708.3±569对270.3±281毫升，p = 0.014）。第1组有3例患者和第2组有2例患者需要输血。术后即刻，第1组和第2组的平均肌酐分别为1.26±0.36和1.45±0.61毫克/分升（p = 0.075）。所有标本的手术切缘均为阴性。病理检查显示肾细胞癌18例（17例为pT1期，1例为pT3a期），嗜酸细胞瘤4例，血管平滑肌脂肪瘤5例，肾腺瘤1例。
腹腔镜部分肾切除术是小肾肿块患者的一种可行选择。在肿瘤切除过程中阻断肾血管并缝合肾脏模仿了开放手术技术，似乎与较少的失血量和较短的腹腔镜手术时间相关。
