Liang Y H, Zu X B, Cheng X, Liu L F
Operation Room, Xiangya Hospital, Central South University, Changsha 410008, China.
Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2017 Aug 18;49(4):608-612.
Retro-laparoscopic partial nephrectomy is a challenge for ventro-renal tumors, especially hilar tumors. The tumors are partial or entirely out of operative field and there is blind space for operation. To solve this problem, a set of techniques including renal pedicle rotation is developed.
A set of techniques including renal pedicle rotation, double-layer suture, early artery unclamping for retro-laparoscopic nephrectomy for ventro-renal tumors, especially hilar tumors were developed. Hilar tumors were located anteriorly to the angle of the renal and renal arteries and in contact with the anterior surface of the renal artery. The evaluation of the outcomes included the operation time, warm ischemia time, estimated haemorrhage, surgical margin, renal function after operation, and complications. This study reviewed the data of 28 patients with ventro-renal tumor, including 15 patients with complex hilar tumors.
The average tumor size was (3.8±0.5) cm. The average R.E.N.A.L score was 8 (ranging from 7 to 9). The average warm ischemia time was (23.8±4.7) min, and suture time was (26.2±6.5) min, and operation time was (124.1±12.1) min. The median hospital stay was 4 days and the average estimated haemorrhage was (139.1±54.0) mL. All the surgeries were operated under laparoscope and no surgery switched to open surgery. Seven patients developed Clavien Dindo I-II complications after operation. Three patients (10.7%) developed collective system damage and received repair of collective system in time and three patients (10.7%) developed slightly gross hematuria (Clavien-Dindo I). Two patients developed wound infection (Clavien-Dind II). Three patients (10.7%) got renal vein clamped because of capillary hemorrhage from basilar part of tumors. There were 14 patients received early unclamping of renal artery, and no obvious renal vessel damage was found. There were statistically significant differences between the serum creatinine levels (P<0.05) and the estimated glomerular filtration rates (P=0.02) before and after surgery. All the patients' serum creatinine levels were in normal range and no patient needed regular dialysis. There was no positive surgical margin and the median follow-up was 7 months without local recurrence or distant metastasis.
It is safe and effective to apply renal pedicle rotation technique in retro-laparoscopic partial nephrectomy for ventro-renal tumors. The short-term follow-up results are optimistic, but long follow-up is required.
后腹腔镜下肾部分切除术对于腹侧肾肿瘤，尤其是肾门肿瘤来说是一项挑战。这些肿瘤部分或完全不在手术视野内，存在手术盲区。为解决这一问题，开发了包括肾蒂旋转在内的一系列技术。
开发了包括肾蒂旋转、双层缝合、早期动脉夹闭等一系列用于后腹腔镜下切除腹侧肾肿瘤（尤其是肾门肿瘤）的技术。肾门肿瘤位于肾动脉夹角前方并与肾动脉前表面接触。对手术结果的评估包括手术时间、热缺血时间、估计出血量、手术切缘、术后肾功能及并发症。本研究回顾了28例腹侧肾肿瘤患者的数据，其中包括15例复杂性肾门肿瘤患者。
肿瘤平均大小为（3.8±0.5）cm。R.E.N.A.L评分平均为8分（范围为7至9分）。平均热缺血时间为（23.8±4.7）分钟，缝合时间为（26.2±6.5）分钟，手术时间为（124.1±12.1）分钟。中位住院时间为4天，平均估计出血量为（139.1±54.0）mL。所有手术均在腹腔镜下完成，无手术转为开放手术。7例患者术后出现Clavien Dindo I-II级并发症。3例患者（10.7%）发生集合系统损伤并及时接受了集合系统修复，3例患者（10.7%）出现轻度肉眼血尿（Clavien-Dindo I级）。2例患者发生伤口感染（Clavien-Dind II级）。3例患者（10.7%）因肿瘤基底部毛细血管出血导致肾静脉夹闭。14例患者接受了肾动脉早期夹闭，未发现明显肾血管损伤。术前和术后血清肌酐水平（P<0.05）及估计肾小球滤过率（P=0.02）存在统计学显著差异。所有患者血清肌酐水平均在正常范围内，无患者需要定期透析。手术切缘均为阴性，中位随访时间为7个月，无局部复发或远处转移。
在腹侧肾肿瘤的后腹腔镜下肾部分切除术中应用肾蒂旋转技术是安全有效的。短期随访结果乐观，但仍需要长期随访。
