腹腔镜部分肾切除术：新趋势
Laparoscopic partial nephrectomy: Newer trends.
作者信息
Aron Monish, Turna Burak
机构信息
Center for Laparoscopic and Robotic Surgery, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
出版信息
Indian J Urol. 2009 Oct-Dec;25(4):516-22. doi: 10.4103/0970-1591.57931.
OBJECTIVES
To report the advances in laparoscopic partial nephrectomy (LPN) for renal masses with emphasis on technically challenging cases.
METHODS
Literature in the English language was reviewed using the National Library of Medicine database using the key words kidney, renal, tumor, nephron sparing surgery, and laparoscopic partial nephrectomy, for the period between 1993 and 2009. Over 500 articles were identified. A total of 50 articles were selected for this review based on their relevance to the evolution of the technique and outcomes, as well as expanding indications for LPN.
RESULTS
In expert hands, LPN is safe and effective for central tumors, completely intrarenal tumors, hilar tumors, tumor in a solitary kidney, large tumors requiring heminephrectomy, cystic tumors, multiple tumors, obese patients, and even incidental stage >/= pT2 tumors. Perioperative outcomes and 5-year oncologic outcomes after LPN are comparable to open partial nephrectomy (OPN).
CONCLUSIONS
In experienced hands indications for LPN have expanded significantly. In 2009, advanced LPN remains a skill-intensive procedure that can nevertheless provide excellent outcomes for patients with renal tumors.
目的
报道腹腔镜肾部分切除术（LPN）治疗肾肿物的进展，重点关注技术上具有挑战性的病例。
方法
使用美国国立医学图书馆数据库，以肾、肾脏、肿瘤、保肾手术和腹腔镜肾部分切除术为关键词，检索1993年至2009年期间的英文文献。共识别出500多篇文章。基于与该技术的发展及结果的相关性，以及LPN适应证的扩展，共选择50篇文章进行本综述。
结果
在专家手中，LPN对于中央型肿瘤、完全位于肾内的肿瘤、肾门肿瘤、孤立肾肿瘤、需要行半肾切除术的大肿瘤、囊性肿瘤、多发肿瘤、肥胖患者，甚至偶然发现的≥pT2期肿瘤都是安全有效的。LPN术后的围手术期结果和5年肿瘤学结果与开放性肾部分切除术（OPN）相当。
结论
在经验丰富的医生手中，LPN的适应证已显著扩大。2009年，先进的LPN仍然是一项技术要求较高的手术，但仍可为肾肿瘤患者带来良好的治疗效果。
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