Guo Gang, Cai Wei, Zhang Xu
Department of Urology, General Hospital of the People's Liberation Army, Beijing 100853, P.R. China.
Oncol Lett. 2016 Nov;12(5):3799-3803. doi: 10.3892/ol.2016.5159. Epub 2016 Sep 21.
The aim of the present study was to investigate a method of laparoscopic nephron-sparing surgery (LNSS) for renal cell carcinoma (RCC) based on the precise anatomy of the nephron, and to decrease the incidence of hemorrhage and urinary leakage. Between January 2012 and December 2013, 31 patients who presented to the General Hospital of the People's Liberation Army (Beijing, China) were treated for RCC. The mean tumor size was 3.4±0.7 cm in diameter (range, 1.2-6.0 cm). During surgery, the renal artery was blocked, and subsequently, an incision in the renal capsule and renal cortex was performed, at 3-5 mm from the tumor edge. Subsequent to the incision of the renal parenchyma, scissors with blunt and sharp edge were used to separate the base of the tumor from the normal renal medulla, in the direction of the ray medullary in the renal pyramids. The basal blood vessels were incised following the hemostasis of the region using bipolar coagulation. The minor renal calyces were stripped carefully and the wound was closed with an absorbable sutures. The arterial occlusion time, duration of surgery, intraoperative bleeding volume, post-operative drainage volume, pathological results and complications were recorded. The surgery was successful for all patients. The estimated average intraoperative bleeding volume was 55.7 ml, the average surgical duration was 95.5 min, the average arterial occlusion time was 21.2 min, the average post-operative drainage volume was 92.3 ml and the average post-operative length of hospital stay was 6.1 days. No hemorrhage or urinary leakage was observed in the patients following the surgery. LNSS for RCC based on the precise anatomy of the nephron was concluded to be effective and feasible. The surgery is useful for the complete removal of tumors and guarantees a negative margin, which may also decrease the incidence of hemorrhage and urinary leakage following surgery.
本研究的目的是基于肾单位的精确解剖结构，探索一种用于肾细胞癌（RCC）的腹腔镜保留肾单位手术（LNSS）方法，并降低出血和尿漏的发生率。2012年1月至2013年12月期间，解放军总医院（中国北京）收治的31例肾细胞癌患者接受了治疗。肿瘤平均直径为3.4±0.7厘米（范围为1.2 - 6.0厘米）。手术过程中，阻断肾动脉，随后在距肿瘤边缘3 - 5毫米处切开肾包膜和肾皮质。切开肾实质后，使用钝锐两用剪刀沿肾锥体髓放线方向将肿瘤基底部与正常肾髓质分离。在该区域使用双极电凝止血后切开基底血管。仔细剥离小肾盏，并用可吸收缝线缝合伤口。记录动脉阻断时间、手术时间、术中出血量、术后引流量、病理结果及并发症。所有患者手术均成功。估计平均术中出血量为55.7毫升，平均手术时间为95.5分钟，平均动脉阻断时间为21.2分钟，平均术后引流量为92.3毫升，平均术后住院时间为6.1天。术后患者未观察到出血或尿漏情况。基于肾单位精确解剖结构的肾细胞癌腹腔镜保留肾单位手术被认为是有效且可行的。该手术有助于完整切除肿瘤并保证切缘阴性，还可能降低术后出血和尿漏的发生率。
