SCDU Urologia, Dipartimento di Scienze Cliniche e Biologiche, Università degli Studi di Torino, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy.
BJU Int. 2011 Jul;108(2):268-73. doi: 10.1111/j.1464-410X.2010.09788.x. Epub 2010 Nov 2.
• To investigate the perioperative safety of laparoscopic partial nephrectomy (LPN) for large renal masses (>4 cm).
• After Institutional Review Board approval, data from 100 consecutive patients who had undergone transperitoneal or retroperitoneal LPN at our institution from January 2005 to June 2009 were obtained from our prospectively maintained database. • The patients were divided into two groups according to radiological tumour size: group A (67 patients) with tumours ≤4 cm and group B (33 patients) with tumours >4 cm. • Demographic, perioperative and pathological data were evaluated.
• The two groups were comparable in terms of demographic data. Mean tumour size was 2.4 and 5 cm (P= 0.0001) for groups A and B, respectively. Group B tumours were more complex, as reflected by significantly more with a central location (P= 0.002), and by significantly more transperitoneal LPNs, pelvicalyceal repairs and longer warm ischaemia time (WIT; 19 vs 28 min). • Complications were recorded in nine group A patients (13.4%) and nine group B patients (27.2%) (P= 0.09). • There was no difference between preoperative and postoperative serum creatinine levels in either group, while a significant difference was found in postoperative estimated glomerular filtration rate between groups (P= 0.004). • The incidence of carcinoma was comparable between the two groups. • The incidence of positive surgical margins (PSMs) was 3.9% in group A, whereas no PSM was recorded in group B (P= 0.3).
• Laparoscopic partial nephrectomy for large tumours is feasible and has acceptable pathological results. However, the complication rate, in particular WIT, remains questionable. • Further studies are required to better clarify the role of LPN in the management of tumours of this size.
探讨腹腔镜部分肾切除术（LPN）治疗大肾肿瘤（＞4cm）的围手术期安全性。
经机构审查委员会批准，从 2005 年 1 月至 2009 年 6 月，我们从前瞻性维护的数据库中获取了在我院接受经腹腔或后腹腔 LPN 的 100 例连续患者的数据。根据影像学肿瘤大小，将患者分为两组：A 组（67 例）肿瘤≤4cm，B 组（33 例）肿瘤＞4cm。评估了患者的人口统计学、围手术期和病理数据。
两组患者的人口统计学数据无差异。A 组和 B 组肿瘤的平均大小分别为 2.4cm 和 5cm（P=0.0001）。B 组肿瘤更复杂，表现为中央位置的肿瘤明显更多（P=0.002），经腹腔 LPN、肾盂修复和更长的热缺血时间（WIT；19 分钟与 28 分钟）也更多。A 组有 9 例（13.4%）和 B 组有 9 例（27.2%）患者发生并发症（P=0.09）。两组患者术前和术后的血清肌酐水平无差异，而术后估算肾小球滤过率在两组之间存在显著差异（P=0.004）。两组的癌发生率相似。A 组的阳性切缘（PSM）发生率为 3.9%，而 B 组无 PSM（P=0.3）。
腹腔镜部分肾切除术治疗大肿瘤是可行的，且有可接受的病理结果。然而，并发症发生率，特别是 WIT，仍存在疑问。需要进一步的研究来更好地阐明 LPN 在这种大小肿瘤的治疗中的作用。
