Cinar Onder, Gunseren Kadir Omur, Cicek Cagatay, Vuruskan Berna Aytac, Vuruskan Hakan
1 Department of Urology, School of Medicine, Bulent Ecevit University, Zonguldak, Turkey.
2 Department of Urology, Uludag University, School of Medicine, Bursa, Turkey.
J Laparoendosc Adv Surg Tech A. 2019 Jan;29(1):35-39. doi: 10.1089/lap.2018.0320. Epub 2018 Jul 13.
We aimed to report surgical and oncological outcomes of renal cell carcinoma (RCC) patients with level I and II thrombus treated with laparoscopic transperitoneal radical nephrectomy.
Medical records of 13 patients were reviewed retrospectively in a single center between 2005 and 2017. Hem-o-lok clips were used to secure renal artery and renal vein, excluding 2 patients with an attached thrombus on the right side.
Seven male and 6 female patients were treated laparoscopically, and conversion to open surgery was not required in any case. The mean age was 61.6 ± 7.8 years (range 45 to 75 years) and the mean body mass index was 27 ± 4.6 kg/m (range 18.8 to 34.5 kg/m). Median tumor size was 9.5 × 7.3 cm (range 5 to 14 cm) and 5 patients who had preoperative metastases underwent cytoreductive nephrectomy. The mean operative time was 137.6 ± 45.8 minutes (range 60 to 200 minutes) and blood loss was 105 ± 34.9 mL (range 50 to 150 mL). The mean hospital stay was 4.4 ± 3.9 days (range 1 to 15 days). Splenic capsular injury occurred in 1 patient and the vena cava was injured in another. Three patients needed blood transfusions. The mean follow-up period was 25 months (range 12 to 86 months).
Laparoscopic transperitoneal radical nephrectomy can be reliable option for surgical management of RCC with level I and II thrombus in experienced centers.
我们旨在报告接受腹腔镜经腹根治性肾切除术治疗的Ⅰ级和Ⅱ级血栓性肾细胞癌（RCC）患者的手术及肿瘤学结局。
回顾性分析了2005年至2017年间单一中心13例患者的病历。使用Hem-o-lok夹夹闭肾动脉和肾静脉，2例右侧有附着血栓的患者被排除。
7例男性和6例女性患者接受了腹腔镜手术，无一例需要转为开放手术。平均年龄为61.6±7.8岁（范围45至75岁），平均体重指数为27±4.6kg/m（范围18.8至34.5kg/m）。肿瘤中位大小为9.5×7.3cm（范围5至14cm），5例术前有转移的患者接受了减瘤性肾切除术。平均手术时间为137.6±45.8分钟（范围60至200分钟），失血量为105±34.9mL（范围50至150mL）。平均住院时间为4.4±3.9天（范围1至15天）。1例患者发生脾包膜损伤，另1例患者腔静脉受损。3例患者需要输血。平均随访期为25个月（范围12至86个月）。
在经验丰富的中心，腹腔镜经腹根治性肾切除术对于Ⅰ级和Ⅱ级血栓性RCC的手术治疗是一种可靠的选择。
