Department of Urology, Montefiore Medical Center, Bronx, New York 10467, USA.
J Endourol. 2012 Jul;26(7):866-70. doi: 10.1089/end.2011.0534. Epub 2012 Apr 26.
Laparoscopic partial nephrectomy (LPN) has become a well-established treatment for patients with selected renal malignancies. As the skills of urologic laparoscopic surgeons have increased, more complex and larger tumors are now being approached in this manner. Laparoscopic heminephrectomy (LHN), defined as the resection of >30% of a kidney, is described in this article. Standardized nephrometry scoring is used to grade tumor complexity; complications, renal function, and perioperative outcomes are discussed.
One hundred forty-five patients underwent minimally invasive partial nephrectomy. Parameters studied included patient demographics, tumor characteristics, operative time, estimated blood loss (EBL), length of stay (LOS), clamp time, change in renal function over time, and complication rate using the Clavien system.
Twenty-four patients underwent LHN. Patients who had LHN performed had significantly larger tumors (4.7 vs 2.6 cm, P=0.05) with higher nephrometry scoring (6.6 vs 5.0, P=0.007). On univariate analysis, both operative (176.0 vs 151.6 min, P=0.036) and clamp time (29.3 vs 21.9 min, P=0.003) were significantly increased. There was no difference in LOS, EBL, change of renal function over time, or complications.
LHN is efficacious and feasible. Although both operative and clamp times were significantly increased, there was no significant impact on LOS, EBL, change in renal function over time, or complication rate.
腹腔镜部分肾切除术（LPN）已成为治疗特定肾恶性肿瘤患者的一种成熟治疗方法。随着泌尿外科腹腔镜外科医生技能的提高，现在以这种方式处理更复杂和更大的肿瘤。本文描述了腹腔镜半肾切除术（LHN），定义为切除肾脏的> 30％。采用标准化肾切除术评分来分级肿瘤的复杂性；讨论并发症，肾功能和围手术期结果。
145 名患者接受了微创部分肾切除术。研究的参数包括患者的人口统计学，肿瘤特征，手术时间，估计失血量（EBL），住院时间（LOS），夹闭时间，随时间推移肾功能的变化以及使用Clavien 系统的并发症发生率。
24 例患者接受了 LHN。接受 LHN 的患者的肿瘤明显更大（4.7 与 2.6 cm，P=0.05），肾切除术评分更高（6.6 与 5.0，P=0.007）。在单因素分析中，手术（176.0 与 151.6 min，P=0.036）和夹闭时间（29.3 与 21.9 min，P=0.003）均明显延长。LOS，EBL，随时间推移肾功能的变化或并发症无差异。
LHN 是有效且可行的。尽管手术和夹闭时间均明显增加，但对 LOS，EBL，随时间推移肾功能的变化或并发症发生率没有明显影响。
