McDougall E M, Elbahnasy A M, Clayman R V
Division of Urology, Mallinckrodt Institute of Radiology, St. Louis, Missouri, USA.
JSLS. 1998 Jan-Mar;2(1):15-23.
Open partial nephrectomy is an accepted form of treatment for a variety of benign conditions and for localized renal cell carcinoma. To date, there is limited experience with the clinical application of laparoscopic partial nephrectomy and wedge resection for benign and malignant disease of the kidney. Herein, we report our clinical experience with laparoscopic partial nephrectomy and a review of the current literature. Twelve patients (27-81 years) have undergone laparoscopic wedge resection (3) or attempted polar partial nephrectomy (9) since 1993. In the group of 12 patients, 5 had a mass suspicious for a malignancy, 4 patients had symptomatic polar calyceal dilation with or without stone disease, and 3 patients had an atrophic or hydronephrotic upper pole moiety. Among the patients in the polar nephrectomy group, a third were converted to an open procedure. The remaining 6 patients had a mean operative time of 6.5 hours (5.7-8.3 hours). These patients resumed their oral intake on average 0.8 days postoperatively. In the 2 patients with a mass, the final pathology was oncocytoma (1), and xanthogranulomatous reaction in a renal cyst (1). Postoperative complications included a nephrocutaneous fistula which was endoscopically fulgurated, a retroperitoneal urinoma which was percutaneously drained, and a two-day bout of ileus. The mean hospital stay was 5.3 days (2-9). Their full convalescence was completed in a mean of 4.2 weeks (2-8). Three patients underwent a wedge resection for a superficial < 2 cm mass. The average operative time in this group was 3.5 hours (2-5.4). The mean time to resuming oral intake was 0.7 days (0.3-0.7). The final pathology was oncocytoma (1), oncocytic renal cell cancer (1), and old infarction (1); none of the patients had any complications. The mean hospital stay was 2.7 days (2-4). Convalescence was completed in 4 weeks (range 1-8). Laparoscopic wedge resection and polar partial nephrectomy are feasible, albeit currently tedious techniques. While wedge excision of a < 2 cm superficial lesion is relatively straightforward and efficient, laparoscopic polar partial nephrectomy remains a difficult technique and at present remains in evolution. Further development of instrumentation to provide for a reliable, expeditious, and hemostatic partial nephrectomy is needed.
开放性部分肾切除术是治疗多种良性疾病和局限性肾细胞癌的一种公认的治疗方式。迄今为止，腹腔镜下部分肾切除术及楔形切除术在肾脏良恶性疾病临床应用方面的经验有限。在此，我们报告我们在腹腔镜下部分肾切除术方面的临床经验并对当前文献进行综述。自1993年以来，12例患者（年龄27 - 81岁）接受了腹腔镜楔形切除术（3例）或尝试性肾极部分切除术（9例）。在这12例患者中，5例有可疑恶性肿块，4例有症状性肾极肾盏扩张伴或不伴结石病，3例有萎缩性或肾积水的上极部分。在肾极切除术组的患者中，三分之一转为开放性手术。其余6例患者的平均手术时间为6.5小时（5.7 - 8.3小时）。这些患者术后平均0.8天恢复经口进食。在2例有肿块的患者中，最终病理结果为嗜酸细胞瘤（1例）和肾囊肿中的黄色肉芽肿反应（1例）。术后并发症包括经内镜电灼的肾皮肤瘘、经皮引流的腹膜后尿瘤和为期两天的肠梗阻。平均住院时间为5.3天（2 - 9天）。他们平均在4.2周（2 - 8周）完全康复。3例患者因浅表＜2 cm的肿块接受了楔形切除术。该组的平均手术时间为3.5小时（2 - 5.4小时）。恢复经口进食的平均时间为0.7天（0.3 - 0.7天）。最终病理结果为嗜酸细胞瘤（1例）、嗜酸细胞性肾细胞癌（1例）和陈旧性梗死（1例）；所有患者均无任何并发症。平均住院时间为2.7天（2 - 4天）。康复在4周内完成（范围1 - 8周）。腹腔镜楔形切除术和肾极部分切除术是可行的，尽管目前是繁琐的技术。虽然对＜2 cm的浅表病变进行楔形切除相对简单且有效，但腹腔镜肾极部分切除术仍然是一项困难的技术，目前仍在发展中。需要进一步开发器械以实现可靠、快速且能止血的部分肾切除术。
