Lu Y N, Zhang F, Hu X Y, Yang N Q, Guo J M, Wang H
Department of Urology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Zhonghua Yi Xue Za Zhi. 2017 Jul 25;97(28):2202-2204. doi: 10.3760/cma.j.issn.0376-2491.2017.28.009.
To investigate the safety and feasibility of mini-flank open nephron sparing surgery (MI-OPN) via retroperitoneal route for the treatment of centrally located renal tumor. From May 2013 to April 2015, twenty-four cases of centrally located renal tumor were treated with MI-OPN via retroperitoneal route in Zhongshan Hospital. All cases were included in this study with whose clinical data and long term follow-up information retrospectively analyzed. With the assistance of intraoperative ultrasonography to confirm tumor location and boundary, MI-OPN was successfully performed in all cases. Mean tumor maximum diameter was 3.3±0.6 cm, mean operation time was 113±16 minutes, mean ischemia time was 31±6 min, and mean estimated blood loss was 102±46 ml. Mean postoperative hospital stay was 5.0±0.8 days, postoperative complication was found in one patient (4%). The mean pre- and postoperative serum creatinine were 77.1±20.1 μmol/L and 90.3±20.0 μmol/L. Pathological examination confirmed negative surgical margin in all cases, with 18 cases of clear cell renal cell carcinoma, 2 cases of papillary renal cell carcinoma, 2 cases of chromophobe renal carcinoma, 1 case of renal oncocytoma and 1 case of renal angiomyolipoma. In up to 12-36 months postoperative follow-up, no local recurrence or systemic progression was witnessed. For the treatment of centrally localized renal tumor, MI-OPN via retroperitoneal route is a safe and feasible operation method. Importantly, rupture of the tumor capsule was effectively avoided during tumor resection with the assistance of ultrasonic position-setting. Furthermore, incidence of severe postoperative complications such as bleeding and damage of collection system were not found since surgical wound of kidney sewn tightly and finely. The last but not the least, by placing ice slush in retroperitoneal cavity, impairment of renal function caused by renal artery clamping can be alleviated due to decreased metabolism.
探讨经后腹腔途径的微创经腰入路保留肾单位手术（MI-OPN）治疗中央型肾肿瘤的安全性和可行性。2013年5月至2015年4月，复旦大学附属中山医院对24例中央型肾肿瘤患者采用经后腹腔途径的MI-OPN进行治疗。收集所有患者的临床资料并进行回顾性分析，随访其远期预后。所有患者均在术中超声辅助下成功完成手术，明确肿瘤位置和边界。肿瘤最大直径平均为（3.3±0.6）cm，手术时间平均为（113±16）min，肾缺血时间平均为（31±6）min，术中估计出血量平均为（102±46）ml。术后住院时间平均为（5.0±0.8）d，术后并发症1例（4%）。术前、术后血清肌酐水平分别为（77.1±20.1）μmol/L和（90.3±20.0）μmol/L。病理检查切缘均阴性，其中透明细胞癌18例，乳头状肾细胞癌2例，嫌色细胞癌2例，肾嗜酸细胞瘤1例，肾血管平滑肌脂肪瘤1例。术后随访12～36个月，均无局部复发及远处转移。对于中央型肾肿瘤，经后腹腔途径的MI-OPN是一种安全可行的手术方式。术中超声定位有助于在切除肿瘤时有效避免肿瘤包膜破裂；肾脏手术创面缝合严密，未出现出血、集合系统损伤等严重并发症；术中于后腹腔放置冰屑，可降低肾脏代谢，减轻肾动脉阻断对肾功能的损害。
