Gallucci Michele, Guaglianone Salvatore, Carpanese Livio, Papalia Rocco, Simone Giuseppe, Forestiere Ester, Leonardo Costantino
Department of Urology, Regina Elena Cancer Institute, Rome, Italy.
Urology. 2007 Apr;69(4):642-5; discussion 645-6. doi: 10.1016/j.urology.2006.10.048.
Laparoscopic partial nephrectomy is currently very hard to perform because of the great difficulty in obtaining renal parenchymal hemostasis during tumor excision and the consequent high risk of bleeding. The aim of this study was to propose a method to decrease the risk of bleeding, consisting of the superselective embolization of tumor vessels before performing the laparoscopic partial nephrectomy.
Fifty patients with small, solitary, enhancing, predominantly exophytic renal tumors underwent a superselective radiographically guided embolization of tumor vessels. An average of 6 hours after embolization, the patients underwent partial laparoscopic nephrectomy, with transperitoneal access and three trocars placed, under balanced general anesthesia. The mean operative time was measured, as was the mean estimated blood loss.
The mean operative time was 90 minutes, the mean estimated blood loss was 200 mL, and the average hospital stay was 6 days. Complications were reported in only 2 patients. The final pathologic evaluation confirmed the diagnosis of renal cell carcinoma in 43 cases. The median follow-up was 11 months and, to date, the examinations have revealed no recurrences in any of the cases.
Superselective embolization is a valid option for laparoscopic partial nephrectomy. The procedure does not require any regional vascular control or clamping, reduces the estimated blood loss, and reduces the operative time.
由于在肿瘤切除过程中实现肾实质止血存在极大困难以及随之而来的高出血风险，目前腹腔镜部分肾切除术很难实施。本研究的目的是提出一种降低出血风险的方法，即在进行腹腔镜部分肾切除术之前对肿瘤血管进行超选择性栓塞。
50例患有小的、孤立的、强化的、主要为外生性肾肿瘤的患者接受了在影像学引导下对肿瘤血管进行的超选择性栓塞。栓塞后平均6小时，患者在平衡全身麻醉下经腹腔入路并放置三个套管针接受部分腹腔镜肾切除术。测量平均手术时间以及平均估计失血量。
平均手术时间为90分钟，平均估计失血量为200毫升，平均住院时间为6天。仅2例患者报告有并发症。最终病理评估在43例中确诊为肾细胞癌。中位随访时间为11个月，迄今为止，检查未发现任何病例有复发。
超选择性栓塞是腹腔镜部分肾切除术的一种有效选择。该手术不需要任何区域血管控制或钳夹，减少了估计失血量，并缩短了手术时间。
