Xu Zhenyu, Zhang Zhengyu, Gao Jianping, Wei Zhifeng, Xu Xiaofeng, Dong Jie, Tang Hao, Yi Xiaoming, Tang Chaopeng, Zhou Wenquan
Department of Urology, Jinling Hospital, Medical School of Nanjing University, 305# East Zhongshan Road, Nanjing 210002, China.
World J Surg Oncol. 2014 Jun 5;12:179. doi: 10.1186/1477-7819-12-179.
The objective of this study was to modify the adrenal gland-sparing strategy based on retroperitoneal laparoscopic radical nephrectomy by reviewing the anatomic relationship between the kidney and the adrenal gland.
From June 2010 to October 2012, a total of 68 patients (45 males and 23 females) with localized renal cell carcinoma were treated at our hospital. The study included 35 cases that were right side and 33 cases that were left, and average patient age was 54.06 years. The average tumor size was 4.7 cm. Tumors were classified via the TNM staging system. All patients underwent adrenal gland-sparing surgery based on retroperitoneal laparoscopic radical nephrectomy.
For each patient, surgery was successful without conversion to open surgery. The average operative time was 56.65 ± 26.60 min, and the mean blood loss was 70.61 ± 60.96 ml. All patients were discharged from the hospital 3 to 8 days after surgery. During surgery, the adrenal gland was slightly lacerated in three cases and the peritoneum showed perforation in six cases. Only one case recurred during the study follow-up.
Based on retroperitoneal laparoscopy radical nephrectomy, this effective adrenal gland-sparing surgery showed direct exposure of tissue and little interference of the upper pole of the kidney. Elevation of the adrenal gland could help with the complete dissection of the adrenal gland from the kidney. The separation of the kidney was rapid, simple and accurate. The probability of adrenal gland damage was reduced. This strategy is recommended for widespread use in T1-2 renal neoplasms.
本研究的目的是通过回顾肾脏与肾上腺之间的解剖关系，对基于后腹腔镜根治性肾切除术的肾上腺保留策略进行改良。
2010年6月至2012年10月，我院共治疗68例局限性肾细胞癌患者（男45例，女23例）。研究包括右侧35例，左侧33例，患者平均年龄54.06岁。肿瘤平均大小为4.7 cm。肿瘤通过TNM分期系统进行分类。所有患者均接受基于后腹腔镜根治性肾切除术的肾上腺保留手术。
每位患者手术均成功，未转为开放手术。平均手术时间为56.65±26.60分钟，平均失血量为70.61±60.96毫升。所有患者术后3至8天出院。手术过程中，3例肾上腺轻度撕裂，6例腹膜穿孔。研究随访期间仅1例复发。
基于后腹腔镜根治性肾切除术的这种有效的肾上腺保留手术显示出组织暴露直接，对肾上极干扰小。肾上腺的抬高有助于将肾上腺从肾脏完全游离。肾脏的分离快速、简单且准确。肾上腺损伤的概率降低。该策略推荐广泛应用于T1-2期肾肿瘤。
