Dong Dexin, Zhang Yushi
Department of Urology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China.
Front Oncol. 2024 May 28;14:1398347. doi: 10.3389/fonc.2024.1398347. eCollection 2024.
This study aimed to explore the feasibility and safety of laparoscopic nephron-sparing surgery (LNSS) for complex renal cystic lesions.
A retrospective study was conducted on 83 cases of complex renal cystic lesions treated with LNSS in our hospital. There were 32 men and 51 women, ranging in age from 24 to 73 years (average, 47.22 ± 9.03 years). The diameter of the cysts was 1.5-5.9 cm (average, 3.44 ± 0.86cm). According to the Bosniak classification, there were 15 cases of type II, 23 cases of type IIF, 29 cases of type III, and 16 cases of type IV complex renal cystic lesions. According to clinical classification based on the difficulty of laparoscopic partial nephrectomy and the depth of the lesion, the 83 complex renal cystic lesions were divided into 48 cases of the extra-renal type, 15 cases of the centrally located type, seven cases of the renal sinus type, and 13 cases of the renal hilum type.
Laparoscopic partial nephrectomy was successful in all 83 patients. The surgical time was 35-102 min (average, 52.13 ± 14.38 min), the intraoperative bleeding volume was 10-200 ml (average, 27.25 ± 12.26 ml), and the renal artery occlusion time was 12-28 min (average, 12.46 ± 4.45 min). There was no significant change in creatinine before and after surgery. The postoperative pathological results showed 71 cases of renal clear cell carcinoma, five cases of low malignant potential multilocular cystic renal tumors, and seven cases of pure renal cysts with all margins negative.
There is potential for the malignant transformation of complex renal cysts into renal cell carcinoma. For complex renal cysts classified as Bosniak IIF or higher, surgical intervention is recommended, and LNSS is safe and effective. The complexity of the surgical procedure varies depending on the location classification of the complex renal cysts.
本研究旨在探讨腹腔镜保留肾单位手术（LNSS）治疗复杂肾囊性病变的可行性和安全性。
对我院83例接受LNSS治疗的复杂肾囊性病变患者进行回顾性研究。其中男性32例，女性51例，年龄24至73岁（平均47.22±9.03岁）。囊肿直径为1.5 - 5.9厘米（平均3.44±0.86厘米）。根据博斯尼亚克分类，II型15例，IIF型23例，III型29例，IV型复杂肾囊性病变16例。根据基于腹腔镜部分肾切除术难度和病变深度的临床分类，83例复杂肾囊性病变分为肾外型48例，中央型15例，肾窦型7例，肾门型13例。
83例患者腹腔镜部分肾切除术均成功。手术时间为35 - 102分钟（平均52.13±14.38分钟），术中出血量为10 - 200毫升（平均27.25±12.26毫升），肾动脉阻断时间为12 - 28分钟（平均12.46±4.45分钟）。术后肌酐水平前后无明显变化。术后病理结果显示肾透明细胞癌71例，低恶性潜能多房囊性肾肿瘤5例，纯肾囊肿7例，切缘均为阴性。
复杂肾囊肿有恶变转化为肾细胞癌的可能。对于博斯尼亚克IIF型及以上的复杂肾囊肿，建议手术干预，LNSS安全有效。手术操作的复杂性因复杂肾囊肿的位置分类而异。
