Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, China; Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Eur Urol. 2021 Feb;79(2):283-289. doi: 10.1016/j.eururo.2020.11.020. Epub 2020 Dec 7.
Partial nephrectomy or angioembolisation is commonly used for sporadic renal angiomyolipomas (RAMLs) with high RENAL scores, but there is a risk of reduced renal function, postoperative complications, and recurrence.
To describe a new technique for off-clamp laparoscopic evacuation of sporadic RAMLs with high RENAL scores that promotes maximal renal function maintenance and low postoperative complication and lesion recurrence rates.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort of patients undergoing off-clamp laparoscopic evacuation for sporadic RAMLs with RENAL scores ≥9 from January 2013 to June 2018 was included.
We highlighted the curettage, suction, packing, and binding (CSPB) technique, a new off-clamp retroperitoneoscopic evacuation technique for sporadic RAMLs.
Demographics, preoperative, intraoperative, and postoperative outcomes were assessed.
A total of 141 cases were included. The median (interquartile range [IQR]) tumour size was 7 (6.2-8.2)cm. The median (IQR) RENAL score was 10 (9-11). The median (IQR) operative time was 80 (65-125) min, with a median (IQR) estimated blood loss of 130 (90-362.5)ml. Conversion to neither open surgery nor standard laparoscopy occurred. The warm ischaemia time was zero for all cases. Postoperatively, 13 minor complications (Clavien grade 1) were recorded. No blood transfusions were reported. The glomerular filtration rate did not change significantly from preoperative period to 12-mo follow-up. Recurrence did not occur at the median follow-up period of 48 (36-60) mo. The retrospective design and lack of a control group are limitations of this study.
Off-clamp retroperitoneoscopic tumour evacuation using the CSPB technique is feasible, safe, and effective for treating complex sporadic RAMLs.
We report a curettage, suction, packing, and binding technique for off-clamp retroperitoneoscopic evacuation of sporadic renal angiomyolipomas that leads to complete lesion clearance, excellent renal function preservation, and minimal perioperative complications.
部分肾切除术或血管栓塞术常用于肾血管平滑肌脂肪瘤（RAML）伴有高 RENAL 评分的患者，但存在肾功能下降、术后并发症和复发的风险。
描述一种新的技术，用于治疗伴有高 RENAL 评分的散发性 RAML，该技术可促进最大限度地保留肾功能，降低术后并发症和肿瘤复发率。
设计、地点和参与者：本研究纳入了 2013 年 1 月至 2018 年 6 月间采用无夹闭腹腔镜下切除术治疗伴有 RENAL 评分≥9 的散发性 RAML 的患者。
我们重点介绍了一种新的无夹闭后腹腔镜下 RAML 清除技术，即刮除、抽吸、填塞和捆绑（CSPB）技术。
评估患者的人口统计学、围手术期和术后结果。
共纳入 141 例患者。肿瘤的中位（四分位间距[IQR]）大小为 7（6.2-8.2）cm。中位（IQR）RENAL 评分为 10（9-11）。中位（IQR）手术时间为 80（65-125）min，中位（IQR）估计出血量为 130（90-362.5）ml。没有患者转为开放手术或标准腹腔镜手术。所有病例的热缺血时间均为零。术后有 13 例（Clavien 分级 1）出现轻微并发症。没有输血。肾小球滤过率在术前至 12 个月随访期间无明显变化。在中位随访 48（36-60）个月时，未发生肿瘤复发。本研究的局限性在于回顾性设计和缺乏对照组。
采用 CSPB 技术行无夹闭后腹腔镜肿瘤清除术治疗复杂的散发性 RAML 是可行、安全和有效的。
我们报告了一种新的技术，即无夹闭后腹腔镜下采用刮除、抽吸、填塞和捆绑（CSPB）技术治疗散发性肾血管平滑肌脂肪瘤，可实现肿瘤完全清除、保留良好的肾功能和最小的围手术期并发症。
