Gill Inderbir S, Colombo Jose R, Frank Igor, Moinzadeh Alireza, Kaouk Jihad, Desai Mihir
Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
J Urol. 2005 Sep;174(3):850-3; discussion 853-4. doi: 10.1097/01.ju.0000169493.05498.c3.
Partial nephrectomy for hilar tumors represents a technical challenge not only for laparoscopic, but also for open surgeons. We report the technical feasibility and perioperative outcomes of laparoscopic partial nephrectomy (LPN) for hilar tumors.
Between January 2001 and September 2004, 25 of 362 patients (6.9%) undergoing LPN for tumor, as performed by a single surgeon, had a hilar tumor. We defined hilar tumor as a tumor located in the renal hilum that was demonstrated to be in actual physical contact with the renal artery and/or renal vein on preoperative 3-dimensional computerized tomography. En bloc hilar clamping with cold excision of the tumor, including its delicate mobilization from the renal vessels, followed by sutured renal reconstruction was performed routinely.
Laparoscopic surgery was successful in all cases without any open conversions or operative re-interventions. Mean tumor size was 3.7 cm (range 1 to 10.3), 4 patients (16%) had a solitary kidney and the indication for LPN was imperative in 10 patients (40%). Pelvicaliceal repair was performed in 22 patients (88%), mean warm ischemia time was 36.4 minutes (range 27 to 48), mean blood loss was 231 cc (range 50 to 900), mean total operative time was 3.6 hours (range 2 to 5) and mean hospital stay was 3.5 days (range 1.5 to 6.7). Histopathology confirmed renal cell carcinoma in 17 patients (68%), of whom all had negative margins. In 2002 or earlier hemorrhagic complications occurred in 3 patients (12%). No kidney was lost for technical reasons.
LPN can be performed in select patients with a hilar tumor. The technical feasibility reported further extends the scope of LPN. To our knowledge the initial experience in the literature is reported.
肾门部肿瘤的部分肾切除术不仅对腹腔镜外科医生，而且对开放手术医生来说都是一项技术挑战。我们报告了腹腔镜下肾门部肿瘤部分肾切除术（LPN）的技术可行性和围手术期结果。
2001年1月至2004年9月，在362例行LPN治疗肿瘤的患者中，有25例（6.9%）为肾门部肿瘤，均由同一外科医生完成。我们将肾门部肿瘤定义为位于肾门的肿瘤，术前三维计算机断层扫描显示其与肾动脉和/或肾静脉实际接触。常规采用整块肾门阻断并冷切除肿瘤，包括从肾血管小心游离肿瘤，随后进行缝合肾重建。
所有病例腹腔镜手术均成功，无中转开放或再次手术干预。肿瘤平均大小为3.7 cm（范围1至10.3），4例（16%）为孤立肾，10例（40%）行LPN的指征为绝对必要。22例（88%）进行了肾盂输尿管修复，平均热缺血时间为36.4分钟（范围27至48），平均失血量为231 cc（范围50至900），平均总手术时间为3.6小时（范围2至5），平均住院时间为3.5天（范围1.5至6.7）。组织病理学证实17例（68%）为肾细胞癌，所有病例切缘均为阴性。2002年或更早，3例（12%）发生出血并发症。无因技术原因导致肾丢失。
LPN可在部分肾门部肿瘤患者中进行。所报告的技术可行性进一步扩大了LPN的范围。据我们所知，本文报告了文献中的初步经验。
