Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York 10065, USA.
J Endourol. 2013 Jan;27(1):34-9. doi: 10.1089/end.2012.0115. Epub 2012 Sep 17.
To report our operative experience and short-term outcomes for the laparoendoscopic single-site (LESS) management of large renal tumors and tumors of advanced stage.
Ten consecutive patients underwent LESS-radical nephrectomy (RN) for large (≥ 7 cm) and/or locally advanced tumors (>T(2)). Intraoperative, postoperative, and short-term follow-up data were analyzed.
Median surgical time was 146 minutes (range 73-164 min), and median estimated blood loss was 100 mL (range 25-400 mL). No procedure needed conversion to open RN or hand-assisted laparoscopic RN. The median hospital stay was 47 hours (range 42 hours-12 days). One (10%) patient had a minor complication (postoperative fever treated with antibiotics) and one (10%) patient had a major complication (small bowel obstruction necessitating reoperation). Of the 10 tumors, 2 were pathologic stage T(1b), 4 were pathologic stage T(2), and 4 were stage T(3a). At a median follow-up of 12.3 months (range 1-16 mos), six (60%) patients were alive without evidence of recurrence, and 4 (40%) patients were alive with disease. Of those four patients, all four had known metastatic disease before surgery.
LESS-RN for large or advanced stage renal masses is a technically challenging operation. In experienced hands, however, it is a safe and feasible therapeutic option for the management of these tumors.
报告我们在腹腔镜单部位（LESS）治疗大肾肿瘤和晚期肿瘤方面的手术经验和短期结果。
连续 10 例患者接受 LESS 根治性肾切除术（RN）治疗大（≥7cm）和/或局部晚期肿瘤（>T(2)）。分析了术中、术后和短期随访数据。
中位手术时间为 146 分钟（范围 73-164 分钟），中位估计出血量为 100 毫升（范围 25-400 毫升）。没有一例需要转为开放性 RN 或手助腹腔镜 RN。中位住院时间为 47 小时（范围 42 小时-12 天）。1 例（10%）患者出现轻微并发症（术后发热，用抗生素治疗），1 例（10%）患者出现严重并发症（小肠梗阻，需要再次手术）。10 个肿瘤中，2 个为病理分期 T(1b)，4 个为病理分期 T(2)，4 个为分期 T(3a)。在中位随访 12.3 个月（范围 1-16 个月）时，6 例（60%）患者无复发生存，4 例（40%）患者带瘤生存。这 4 例患者在手术前均有已知的转移疾病。
对于大体积或晚期肾肿瘤，LESS-RN 是一项具有挑战性的手术。然而，在有经验的医生手中，它是治疗这些肿瘤的一种安全可行的治疗选择。
