Neri Fabio, Berardinelli Francesco, Cindolo Luca, Sountoulides Petros, Pellegrini Fabrizio, Mirone Vincenzo, Schips Luigi
Department of Urology, S.Pio da Pietrelcina Hospital Vasto, Italy.
Surg Technol Int. 2013 Sep;23:29-33.
Nephron-sparing surgery (NSS) ensures equivalent oncological results while improving overall survival compared with radical nephrectomy when applied to the treatment of small renal masses, moreover warm ischemia is associated with a risk of acute renal failure and advanced chronic kidney disease (CKD). Laparoendoscopic single-site (LESS) unclamp NSS is the next step forward in the management of small renal masses. From 2009 to 2013 we have treated 23 patients with small renal masses ( < 4 cm) amenable to the LESS approach using unclamp LESS NSS. In 20 cases we were able to complete the operation using LESS, in 3 cases conversion to standard laparoscopy was required. Pathologic examination revealed 16 cases of clear-cell renal cell carcinoma (RCC), 4 cases of renal cysts, 2 oncocytomas, and 1 angiomyolipoma. We did not find any significant variation in renal function or any case of tumor recurrence, and the majority of the patients were very satisfied of the cosmetic results. LESS unclamp partial nephrectomy is a safe and feasible procedure, oncological outcomes are similar to standard laparoscopy, there is an advantage with respect to renal function and cosmesis, although the procedure is more technically demanding compared with standard laparoscopy.
保留肾单位手术（NSS）在应用于小肾肿瘤治疗时，与根治性肾切除术相比，能确保同等的肿瘤学效果，同时提高总生存率。此外，热缺血与急性肾衰竭和晚期慢性肾脏病（CKD）风险相关。经自然腔道内镜手术（LESS）无阻断NSS是小肾肿瘤治疗的下一步进展。2009年至2013年，我们采用LESS无阻断NSS治疗了23例适合LESS手术的小肾肿瘤（<4 cm）患者。20例患者能够通过LESS完成手术，3例需要转为标准腹腔镜手术。病理检查显示16例透明细胞肾细胞癌（RCC）、4例肾囊肿、2例嗜酸细胞瘤和1例肾血管平滑肌脂肪瘤。我们未发现肾功能有任何显著变化，也未出现任何肿瘤复发病例，且大多数患者对美容效果非常满意。LESS无阻断部分肾切除术是一种安全可行的手术，肿瘤学结果与标准腹腔镜手术相似，在肾功能和美容方面具有优势，尽管该手术在技术上比标准腹腔镜手术要求更高。
