Lee Benjamin R
Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
Int Braz J Urol. 2002 Nov-Dec;28(6):504-9.
Laparoscopic radical nephrectomy has established its role as a standard of care for the management of renal neoplasms. Long term follow-up has demonstrated laparoscopic radical nephrectomy has shorter patient hospitalization and effective cancer control, with no significant difference in survival compared with open radical nephrectomy. For renal masses less than 4cm, partial nephrectomy is indicated for patients with a solitary kidney or who demonstrate impairment of contralateral renal function. The major technical issue for success of laparoscopic partial nephrectomy is bleeding control and several techniques have been developed to achieve better hemostatic control. Development of new laparoscopic techniques for partial nephrectomy can be divided into 2 categories: hilar control and warm ischemia vs. no hilar control. Development of a laparoscopic Satinsky clamp has achieved en bloc control of the renal hilum in order to allow cold knife excision of the mass, with laparoscopic repair of the collecting system, if needed. Combination of laparoscopic partial nephrectomy with ablative techniques has achieved successful excision of renal masses with adequate hemostasis without hilar clamping. Other techniques without hilar control have been investigated and included the use of a microwave tissue coagulator. In conclusion, laparoscopic radical nephrectomy for renal cell carcinoma has clearly demonstrated low morbidity and equivalent cancer control. The rates for local recurrences and metastatic spread are low and actuarial survival high. Furthermore, laparoscopic partial nephrectomy has demonstrated to be technically feasible, with low morbidity. With short term outcomes demonstrating laparoscopic partial nephrectomy as an efficacious procedure, the role of laparoscopic partial nephrectomy should continue to increase.
腹腔镜根治性肾切除术已确立其作为肾肿瘤治疗标准术式的地位。长期随访表明，腹腔镜根治性肾切除术患者住院时间较短，且能有效控制癌症，与开放性根治性肾切除术相比，生存率无显著差异。对于直径小于4cm的肾肿块，对于孤立肾患者或对侧肾功能受损的患者，应行部分肾切除术。腹腔镜部分肾切除术成功的主要技术问题是出血控制，目前已开发出多种技术以实现更好的止血控制。腹腔镜部分肾切除术新的技术发展可分为两类：肾门控制和热缺血与非肾门控制。腹腔镜Satinsky钳的研发实现了对肾门的整块控制，以便在需要时用冷刀切除肿块，并对集合系统进行腹腔镜修复。腹腔镜部分肾切除术与消融技术相结合，已成功切除肾肿块，实现了充分止血且无需肾门阻断。其他非肾门控制技术也已得到研究，包括使用微波组织凝固器。总之，腹腔镜根治性肾切除术治疗肾细胞癌已明确显示出低发病率和等效的癌症控制效果。局部复发和转移扩散率低，预期生存率高。此外，腹腔镜部分肾切除术已证明在技术上是可行的，发病率低。短期结果表明腹腔镜部分肾切除术是一种有效的手术方式，其作用应会持续增强。
