关键词: 后腹腔镜手术, 保留肾单位手术, 开放手术

Abstract: Objective： To evaluate the clinical effect and safety of retroperitoneal laparoscopic surgery combined with miniflank incision “hybrid surgery” for partial nephrectomy of complex renal tumors. Methods: Between April 2015 and December 2016, the clinical data from 16 patients with complex renal tumors who underwent the “hybrid surgery”, including 10 males and 6 females, were retrospectively reviewed. The average age was (50.2±10.7) years, 9 cases were located in the left side and 7 cases in the right side, the mean tumor size was （6.1±1.0） cm, and the mean R.E.N.A.L. nephrometry score was 9.3±1.3. All the patients received the “hybrid surgery”, the first step was to adequately mobilize the kidney and tumor, prepared the renal artery by retroperitoneal laparoscopy, and then the incision about 10-12 cm was  done under the twelve rib to convert to open surgery. After the renal artery was clamped, the tumor was removed and the wound was closed under direct vision. The operative time, ischemia time, estimated blood loss, intraoperative and postoperative complications and short-term renal function were recorded. Results: All the 16 patients’ “hybrid surgeries” were successfully performed. The mean operative time was (164.9±23.6) min, mean ischemia time was (32.4±6.2) min, and mean estimated blood loss was (204.0±125.1) mL. The mean drainage tube removal time was (4.1±1.0) d, and the mean postoperatively hospital stay was (6.9±1.5) d. There were 2 patients with Clavien Ⅲ grade complications. One patient was injured with collecting system, and 1 patient received a second emergency surgery for acute postoperative bleeding. The mean 1 day postoperative serum creatinine level was (126.3±26.4) μmol/L, which was statistically significant (P<0.05) compared with the preoperative serum creatinine level（74.3±16.9）μmol/L. There were no significant differences (P>0.05) in comparing the 1 month postoperative serum creatinine level（92.6±18.2） μmol/L, 3 months postoperative serum creatinine level （80.8±18.4） μmol/L with the preoperative serum creatinine level. During 3 to 20 months follow-up periods, no local recurrence or distant metastasis occurred. Conclusion: This “hybrid surgery” combined retroperitoneal laparoscopic surgery with mini-flank incision for partial nephrectomy is safe and effective. It could decrease the operative difficulty and be worthy of further application for some selected complex renal tumor patients.

Key words: Retroperitoneal laparoscopic surgery, Nephron sparing surgery, Open surgery