Rodríguez-Covarrubias Francisco, Gabilondo Bernardo, Borgen José L, Gabilondo Fernando
Department of Urology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Colonia Sección XVI, 14000 Tlalpan, Mexico City, México.
Int Urol Nephrol. 2007;39(1):43-6. doi: 10.1007/s11255-006-9069-6. Epub 2007 Feb 20.
To describe our experience with partial nephrectomy using selective parenchymal clamping for the treatment of renal tumors.
Between 2003 and 2005, seven patients with solid renal tumors underwent partial nephrectomy with selective parenchymal clamping at our Institution. In five, the tumor was in the right kidney and in two the tumor was in the left. Only one patient had a tumor within a solitary kidney. The tumor was located in the upper pole in 2 patients and in the lower pole in 5. Partial nephrectomy was performed with the DeBakey aortic clamp without occlusion of renal vessels.
Mean operative time was 236 min (range 175-298 min). Mean intraoperative blood loss was 485 ml with only one patient requiring blood transfusion. There were no major complications. Mean preoperative serum creatinine level was 0.74 mg/dl (range 0.58-1.26 mg/dl) and mean postoperative serum creatinine level was 0.81 mg/dl (range 0.69-1.21 mg/dl) with no patient requiring dialysis. Mean hospital postoperative stay was 5 days (range 4-7 days). Mean tumor size was 2.9 cm (range 1.3-4.0 cm). Pathologic analysis detected renal cell carcinoma in 5 patients, angiomyolipoma in 1 and fibrosis with chronic hemorrhage in 1, all with negative surgical margins. After a mean follow-up of 18 months (range 3-32 months), all patients are free of disease recurrence.
Partial nephrectomy with selective parenchymal clamping allows resection of solid masses without damage to normal renal tissue, avoids the risk of renal failure and offers an excellent local cancer control.
描述我们使用选择性实质钳夹行部分肾切除术治疗肾肿瘤的经验。
2003年至2005年间，7例实性肾肿瘤患者在我院接受了选择性实质钳夹下的部分肾切除术。其中5例肿瘤位于右肾，2例位于左肾。仅1例患者肿瘤位于孤立肾内。2例患者肿瘤位于上极，5例位于下极。使用德巴凯主动脉夹进行部分肾切除术，未阻断肾血管。
平均手术时间为236分钟（范围175 - 298分钟）。平均术中失血量为485毫升，仅1例患者需要输血。无严重并发症。术前血清肌酐平均水平为0.74毫克/分升（范围0.58 - 1.26毫克/分升），术后血清肌酐平均水平为0.81毫克/分升（范围0.69 - 1.21毫克/分升），无患者需要透析。术后平均住院时间为5天（范围4 - 7天）。平均肿瘤大小为2.9厘米（范围1.3 - 4.0厘米）。病理分析发现5例为肾细胞癌，1例为血管平滑肌脂肪瘤，1例为伴有慢性出血的纤维化，所有患者手术切缘均为阴性。平均随访18个月（范围3 - 32个月）后，所有患者均无疾病复发。
选择性实质钳夹下的部分肾切除术能够切除实性肿块而不损伤正常肾组织，避免了肾衰竭风险，并提供了良好的局部癌症控制。
