北京大学学报(医学版) ›› 2018, Vol. 50 ›› Issue (4): 700-704.doi: 10.3969/j.issn.1671-167X.2018.04.022

• 技术方法 • 上一篇    下一篇

后腹腔镜下肿瘤吸除术与肾部分切除术治疗肾血管平滑肌脂肪瘤的安全性与有效性对比

徐奔,张喆楠,罗程,宋海峰,张骞△   

  1. (北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿、男性生殖系肿瘤研究中心, 北京100034)
  • 出版日期:2018-08-18 发布日期:2018-08-18
  • 通讯作者: 张骞 E-mail:zhangqian@bjmu.edu.cn

Comparison of safety and effectiveness between retroperitoneal laparoscopic tumor aspiration and laparoscopic partial nephrectomy in the treatment of renal angiomyolipoma

XU Ben, ZHANG Zhe-nan, LUO Cheng, SONG Hai-feng, ZHANG Qian△   

  1. (Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China)
  • Online:2018-08-18 Published:2018-08-18
  • Contact: ZHANG Qian E-mail:zhangqian@bjmu.edu.cn

摘要:  目的:比较分析后腹腔镜下肿瘤吸除术与肾部分切除术治疗肾血管平滑肌脂肪瘤(又称肾错构瘤)的安全性和有效性。方法:回顾性分析2010年8月至2016年8月在北京大学第一医院就诊行手术治疗的肾血管平滑肌脂肪瘤患者,入组患者121例,能有效搜集资料并完成随访者共74例。将74例患者根据实施术式的不同分成两组:采用后腹腔镜下肿瘤吸除术治疗的共43例(A组),采用后腹腔镜肾部分切除术治疗的共31例(B组),将两组患者的围术期及术后复查数据进行统计及比较。结果:两组患者治疗前各项基本数据差异无统计学意义。A组与B组相比,手术出血量(48.7 mL vs. 102.9 mL)、热缺血时间(21.2 min vs. 28.5 min)、手术时间(70.1 min vs. 103.6 min)上差异有统计学意义(P<0.05)。A组患者围术期无并发症发生,B组患者发生出血2例、漏尿1例,均经保守治疗好转,两组患者并发症的发生率差异有统计学意义。A组患者术后平均肌酐水平1.13 mg/dL,B组患者术后平均肌酐水平1.08 mg/dL,两组间差异无统计学意义。在平均52.6个月的随访期内,A组患者复发3例(7.0%), B组患者复发2例(6.5%),两组患者无瘤复发生存率差异无统计学意义。结论:后腹腔镜下肿瘤吸除术治疗肾血管平滑肌脂肪瘤出血量更少、手术时间更短,与传统的肾部分切除术相比,安全性方面可能具有一定的潜在优势,且肿瘤复发率低、无瘤复发生存期长,能取得与肾部分切除术相同的有效性。

关键词:  肾肿瘤, 血管肌脂瘤, 腹腔镜检查

Abstract: Objective: To compare the safety and treatment effectiveness of retroperitoneal laparoscopic tumor aspiration and laparoscopic partial nephrectomy (LPN) in the treatment of renal angiomyolipoma (RAML). Methods: We retrospectively reviewed the clinical data of patients with pathologically confirmed RAML who received operation between August 2010 and August 2016 in the Department of Urology, Peking University First Hospital. Among them, a series of 121 patients were included in this trial according to the inclusion criteria, of which 74 cases could be collected and followed-up effectively. Based on the detailed surgical route, the 74 patients were divided into groups A and B: group A, which underwent retroperitoneal laparoscopic tumor aspiration, included 43 cases; group B, which received retro-peritoneal LPN, included 31 cases. Patient demographics, intraoperative variables and postoperative outcomes were reported and compared between the groups. Results: No statistical difference was detected in both groups before the treatment. Intraoperatively, the mean estimated blood loss was 48.7 mL in group A and 102.9 mL in group B, and the mean operative time was 70.1 min (21.2 min of warm ischemia time included) in group A and 103.6 min (28.5 min of warm ischemia time included) in group B, which were both statistically different. In group A, no complications occurred and yet 2 complications of transfusion and 1 complication of urine leakage were discovered in group B, although all finally recovered only with conservative treatment. A statistical difference was observed in the complication rates. Post-operatively, the mean serum creatinine level was 1.13 mg/dL in group A, and the level was 1.08 mg/dL in group B, in which no evident difference was detected. In a mean 52.6-months’ follow-up, a recurrence of 3 cases in group A (7.0%) and a recurrence of 2 cases in group B (6.5%) were reported. No evident difference was also detected between the groups in the tumor recurrence rates. Conclusion: Due to the improvements in the intraoperative blood loss and operative time, retroperitoneal laparoscopic tumor aspiration may be provided with more potential advantages in the safety, also with equal efficacy of lower tumor recurrence rates when compared with the traditional retroperitoneal LPN in the treatment of RAML.

Key words: Kidney neoplasms, Angiomyolipoma, Laparoscopy

中图分类号: 

  • R737.11
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