摘要
目的：总结经后腹腔镜保留肾单住手术治疗双肾多发嫌色细胞癌的手术体会，并结合文献进行分析。方法：患者取完全健侧卧位，患侧向上，升高腰桥。分别于腋后线12肋下缘、腋前线肋弓下、腋中线髂棘上2cm穿刺10mm、5mm、10mmTrocar，气腹压力维持在13～15mmHg，建立后腹腔，完成后腹腔镜右肾部分切除、肿瘤剜除术。1个月后完成后腹腔镜左肾部分切除、肿瘤剜除术。结果：手术顺利完成，手术时间90min，术中出血量约为30ml，血管阻断时间23min。患者右侧手术后第2天肛门通气并进饮食，第2天拔除腹膜后引流管。左侧手术后第2天拔除腹膜后引流管，第3天肛门通气并进饮食。住院6d。术后随访1年，无复发、转移。结论：双肾同时性、多发嫌色细胞癌非常罕见，行后腹腔镜保留肾单位手术是安全、可行、有效的。
Objective： To summarize the clinical experience of retroperitoneal laparoscopic nephron-sparing surgery for synchro- nous bilateral multiple chromophobe cell renal carcinoma and analyze with literatures. Methods：One patient ,with synchronous bilateral multiple chromophobe cell renal carcinoma, was treated by retroperitoneal laparoscopic nephron-sparing surgery. The patient was in com- pletely contralateral lying position and the affected side was up. The lumbodorsal fascia was stripped with a long curved forceps, and the index finger stretched into the retroperitoneal space and stripped it,the self-made balloon was introduced into the retroperitoneal space and filled with 800-1 000 ml gas, maintaining 3-5 min. The retroperitoneal space was established, with CO2 gas filled and the pressure of 13-15 mmHg. 10 mm,5 mm and 10 mm Trocars were introduced into the retroperitoneal space through 12 rib margin of the posterior ax- illary line, anterior axillary line under the costal arch and 2 cm above the iliac spine and midaxillary line, respectively. Retroperitoneal laparoscopic right nephron-sparing surgery was performed and 1 month later retroperitoneal laparoscopic left nephron-sparing surgery was performed. Results：The procedure was successfully finished without intraoperative and postoperative complications. The operation time was 90 min, blood loss was about 30 ml, and mean vascular blocking time was 23 min. The drainage tube was removed and the pa- tient resumed diet on the second day after retroperitoneal laparoscopic right nephron-sparing surgery. The drainage tube was removed on the second day and the patient resumed diet 3- days after retroperitoneal laparoscopic left nephron-sparing surgery. The hospital stay was 6 d. The patient recovered well without any evidence of recurrence or metastasis during 1 year follow-up. Conclusions ： Synchronous bi- lateral multiple chromophobe cell renal carcinoma is very rare, retroperitoneal laparoscopic nephron-sparing surgery is safe, feasible and effective.
出处
《腹腔镜外科杂志》
2014年第2期89-92,共4页
Journal of Laparoscopic Surgery
关键词
肾肿瘤
嫌色细胞癌
保留肾单位手术
腹腔镜检查
腹膜后路径
Kidney neoplasms
Cbromophobe cell carcinoma
Nephron-sparing surgery
Laparoscopy
Retroperitoneat approach
