Chen H X, Hu X Y, Guo J M, Wang G M, Wang H
Department of Urology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Zhonghua Yi Xue Za Zhi. 2016 Nov 1;96(40):3236-3238. doi: 10.3760/cma.j.issn.0376-2491.2016.40.008.
To evaluate the safety and efficacy of mini-flank incision for open partial nephrectomy for stage T renal tumor. The data of patients with stage T renal tumor who underwent mini-flank incision for open partial nephrectomy between January 2010 to September 2015 were retrospectively reviewed. The Nephron-sparing surgery (NSS) was performed through mini-flank supra-12th rib incision under general anesthesia. A total of 47 patients(31 male and 16 female) were enrolled in our study. The median age was 40 years (range 22-67 years). The Zhongshan Score(ZS score) of renal tumors was 6 in 5 cases, 7 in 13 cases, 8 in 12 cases, 9 in 5 cases, 10 in 6 cases, 11 in 2 cases, 12 in 2 cases, 13 in 2 cases. The length of incision was from 7 cm to 9 cm, with an average of 8.1 cm. The operative time was from 70 min to 150 min, with an average of 96 min. The blood loss was from 50 ml to 600 ml, with an average of 135 ml. The warm ischemia time was from 20 min to 35 min, with an average of 28 min. All of the surgery margin were negative. One patient had fluid in surgical region and relieved after the drainage, and one patient had acute myocardial infarction. The hospital stay time was from 5 d to 14 d, with an average of 8 d. The pathological diagnosis included clear cell carcinoma in 37 cases, multilocular cystic renal carcinoma in 1 case, chromophobe cell tumor in 4 cases, and papillary carcinoma in 5 cases. The mean preoperative serum creatinine level was 87 μmol/L(48-150 μmol/L) and with a mean of 91 μmol/L(52-148 μmol/L) at 3 month follow-up after surgery, and there was no difference between the preoperative and postoperative period(>0.05). A total of 45 out of 47 patients were followed up for 36 to 78 months, with an average of 60 months, and no one had recurrence or metastasis during follow-up. Mini-flank incision for open partial nephrectomy for renal tumor with stage T is safe and effective, which is worthy of promotion and application for small incision and quick recovery.
评估微创侧腹切口在T期肾肿瘤开放性部分肾切除术中的安全性和有效性。回顾性分析2010年1月至2015年9月期间接受微创侧腹切口开放性部分肾切除术的T期肾肿瘤患者的数据。在全身麻醉下，通过微创侧腹第12肋上切口进行保肾手术（NSS）。本研究共纳入47例患者（男31例，女16例）。中位年龄为40岁（范围22 - 67岁）。肾肿瘤的中山评分（ZS评分）：5例为6分，13例为7分，12例为8分，5例为9分，6例为10分，2例为11分，2例为12分，2例为13分。切口长度为7 cm至9 cm，平均8.1 cm。手术时间为70分钟至150分钟，平均96分钟。出血量为50 ml至600 ml，平均135 ml。热缺血时间为20分钟至35分钟，平均28分钟。所有手术切缘均为阴性。1例患者手术区域有积液，引流后缓解，1例患者发生急性心肌梗死。住院时间为5天至14天，平均8天。病理诊断包括透明细胞癌37例，多房囊性肾细胞癌1例，嫌色细胞肿瘤4例，乳头状癌�例。术前血清肌酐平均水平为87 μmol/L（48 - 150 μmol/L），术后3个月随访时平均为91 μmol/L（52 - 148 μmol/L），术前和术后无差异（>0.05）。47例患者中45例随访36至78个月，平均60个月，随访期间无复发或转移。微创侧腹切口在T期肾肿瘤开放性部分肾切除术中安全有效，因其切口小、恢复快，值得推广应用。
