急诊腹膜后腹腔镜下肾血管平滑肌脂肪瘤破裂部分肾切除术：一项15例单中心回顾性研究系列
Emergency retroperitoneal laparoscopic partial nephrectomy for ruptured renal angiomyolipomas: a retrospective single-center series of 15 cases.
作者信息
He Wei, Chen Xiaoxu, Ji Haiyong, Wang Jianwei, Niu Zhihong
机构信息
Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Huaiyin District, Jinan, 250021, Shandong province, China.
Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong province, China.
出版信息
BMC Surg. 2020 Mar 30;20(1):59. doi: 10.1186/s12893-020-00723-w.
BACKGROUND
To assess the safety, tumor control and renal function preservation of the emergency retroperitoneal laparoscopic partial nephrectomy (LPN) for ruptured renal angiomyolipoma (AML) and summarize our single-center initial experience.
METHODS
We performed a retrospective analysis of 15 patients pathologically confirmed renal AML treated with emergency retroperitoneal LPN between January 2016 and May 2019. The patient demographics, operation time, blood loss, transfusion requirements, complications and other surgical parameters were analyzed. Follow-up was performed by serum creatinine and imaging modalities.
RESULTS
Fifteen patients were performed with emergency LPN with the median age 41.6 years. The mean size of the renal AMLs was 7.8 cm. The mean size of the retroperitoneal hematomas was 8.5 cm. All the emergency surgeries were performed successfully without any conversion to nephrectomy or open surgery. The mean operative time was 101 min. The mean warm ischemia time was 28 min. The mean estimated blood loss was 311 ml. Five patients required intraoperative blood transfusion (33.3%, 5/15). The mean transfused RBC was 4 U (range 2-6 U), and the mean transfused plasma was 200 ml (range 200-400 ml). The mean drainage duration was 3 days (range 2-5 days). The mean postoperative hospitalization was 4.7 days. No patients experienced intraoperative complications. The mean serum creatine was slightly higher after surgery (53.1 vs. 55.9 μmol/L). One patient had postoperative perirenal fluid collection. No patients needed dialysis. No recurrence was observed in the patients at the median follow-up of 24.1 months.
CONCLUSIONS
Our initial experience shows that the emergency retroperitoneal LPN is a safe, minimally invasive procedure for emergency patients with ruptured renal AMLs. It could be considered as an effective alternative to renal artery embolization in selected emergency patients.
背景
评估急诊腹膜后腹腔镜下肾部分切除术（LPN）治疗破裂肾血管平滑肌脂肪瘤（AML）的安全性、肿瘤控制情况及肾功能保留情况，并总结我们单中心的初步经验。
方法
我们对2016年1月至2019年5月期间接受急诊腹膜后LPN治疗的15例经病理确诊为肾AML的患者进行了回顾性分析。分析了患者的人口统计学资料、手术时间、出血量、输血需求、并发症及其他手术参数。通过血清肌酐和影像学检查进行随访。
结果
15例患者接受了急诊LPN，中位年龄为41.6岁。肾AML的平均大小为7.8cm。腹膜后血肿的平均大小为8.5cm。所有急诊手术均成功完成，无一例转为肾切除术或开放手术。平均手术时间为101分钟。平均热缺血时间为28分钟。平均估计出血量为311ml。5例患者术中需要输血（33.3%，5/15）。平均输注红细胞4U（范围2 - 6U），平均输注血浆200ml（范围200 - 400ml）。平均引流持续时间为3天（范围2 - 5天）。平均术后住院时间为4.7天。无患者发生术中并发症。术后血清肌酐均值略有升高（53.1对55.9μmol/L）。1例患者术后出现肾周积液。无患者需要透析。在中位随访24.1个月时，患者未观察到复发。
结论
我们的初步经验表明，急诊腹膜后LPN对于肾AML破裂的急诊患者是一种安全、微创的手术方法。在部分急诊患者中，可将其视为肾动脉栓塞的有效替代方法。
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