Janetschek G, Daffner P, Peschel R, Bartsch G
Department of Urology, University of Innsbruck, Austria.
J Urol. 1998 Apr;159(4):1152-5.
In recent years the detection rate for small renal tumors has increased due to the widespread use of advanced diagnostic imaging techniques, which in turn has increased the need for nephron sparing surgery. We investigate whether laparoscopic surgery is a suitable approach to partial resection of small renal tumors.
Between June 1994 and October 1996, 7 patients underwent laparoscopic wedge resection of the kidney for renal tumors up to 2 cm. in diameter. Hemostasis was achieved mainly by bipolar coagulation. In addition, the resection surface was cauterized with an argon beam coagulator and then sealed with fibrin glue. In 1 procedure a novel ultrasonic dissector was tested.
All procedures could be completed as planned. The only intraoperative complication was a pneumothorax that resolved spontaneously within 2 days. There were no postoperative complications. Histological examination yielded stage pT1 grade I renal cell carcinoma in 3, stage pT1 grade II in 2 and multilocular cysts in 2 cases. All patients had negative surgical margins. Postoperatively, renal function as assessed by serum creatinine was unchanged. Neither local recurrences nor metastases were observed during a followup of 7 to 35 months.
Our results indicate that laparoscopic partial nephrectomy is feasible for small renal cell carcinoma, and is associated with low morbidity and a low complication rate.
近年来，由于先进诊断成像技术的广泛应用，小肾肿瘤的检出率有所提高，这反过来又增加了对保留肾单位手术的需求。我们研究腹腔镜手术是否是小肾肿瘤部分切除术的合适方法。
1994年6月至1996年10月期间，7例患者因直径达2厘米的肾肿瘤接受了腹腔镜肾楔形切除术。止血主要通过双极电凝完成。此外，切除表面用氩束凝固器烧灼，然后用纤维蛋白胶封闭。在1例手术中测试了一种新型超声解剖器。
所有手术均按计划完成。唯一的术中并发症是气胸，在2天内自行缓解。无术后并发症。组织学检查显示3例为pT1期I级肾细胞癌，2例为pT1期II级，2例为多房囊肿。所有患者手术切缘均为阴性。术后，通过血清肌酐评估的肾功能未改变。在7至35个月的随访期间，未观察到局部复发或转移。
我们的结果表明，腹腔镜部分肾切除术对小肾细胞癌是可行的，且发病率低、并发症发生率低。
