Ehsanullah Syed Ali, Sultana Abida, Kelly Brian, Dunford Charlotte, Shah Zaheer
Worcestershire Acute Hospitals NHS Trust, Redditch, UK.
University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Adv Urol. 2021 Dec 31;2021:5569254. doi: 10.1155/2021/5569254. eCollection 2021.
To assess a minimally invasive open technique for partial nephrectomy with zero ischaemia time.
A review was performed in a prospectively maintained database of a single surgeon series of all patients undergoing partial nephrectomy using a supra 12 rib miniflank incision with zero ischaemia. Data of seventy one patients who underwent a partial nephrectomy over an 82-month period were analyzed. Data analyzed included operative time, estimated blood loss, pre and postoperative renal function, complications, final pathological characteristics, and tumour size.
Seventy one partial nephrectomies were performed from February 2009 to October 2015. None were converted to radical nephrectomy. Mean operative time was 72 minutes (range 30-250), and mean estimated blood loss was 608 mls (range 100-2500) with one patient receiving blood transfusion. The mean pre and postoperative haemoglobin levels were 144 and 112 g/l. The mean pre and postoperative creatinine levels were 82 and 103 Umol/L. There were 8 Clavian-Dindo Grade 2 complications and 1 major complication (Clavian IIIa). Histology confirmed 24 benign lesions and 47 malignant lesions, 46 cT1a lesions, 24 cT1b lesions, and 1 cT2 lesion. Median follow-up was 38 months with no local recurrence or progression of disease with 5 patients having a positive margin (7%).
Our results demonstrate that a supra 12th miniflank incision open partial nephrectomy with zero ischaemic time for SRMs has satisfactory outcomes with preservation of renal function. A minimally invasive open partial nephrectomy remains an important option for units that cannot offer patients a laparoscopic or a robotic procedure.
评估一种零缺血时间的微创开放性部分肾切除术技术。
对一个前瞻性维护的数据库进行回顾，该数据库包含一位外科医生采用第12肋以上小切口且零缺血技术进行部分肾切除术的所有患者系列。分析了在82个月期间接受部分肾切除术的71例患者的数据。分析的数据包括手术时间、估计失血量、术前和术后肾功能、并发症、最终病理特征以及肿瘤大小。
2009年2月至2015年10月共进行了71例部分肾切除术。无一例转为根治性肾切除术。平均手术时间为72分钟（范围30 - 250分钟），平均估计失血量为608毫升（范围100 - 2500毫升），1例患者接受了输血。术前和术后血红蛋白水平的平均值分别为144克/升和112克/升。术前和术后肌酐水平的平均值分别为82微摩尔/升和103微摩尔/升。有8例Clavien - Dindo 2级并发症和1例主要并发症（Clavien IIIa级）。组织学证实24例为良性病变，47例为恶性病变，46例为cT1a病变，24例为cT1b病变，1例为cT2病变。中位随访时间为38个月，无局部复发或疾病进展，5例患者切缘阳性（7%）。
我们的结果表明，对于小肾实质性肿瘤，采用第12肋以上小切口开放性部分肾切除术且零缺血时间可获得满意的结果，并能保留肾功能。对于无法为患者提供腹腔镜或机器人手术的单位，微创开放性部分肾切除术仍然是一个重要的选择。
