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目的:探讨后腹腔镜保留肾单位手术治疗肾错构瘤的手术技巧和临床效果。方法:采用后腹腔镜技术对20例肾错构瘤患者行肿瘤剜除术。其中择期手术患者19例,因肾错构瘤破裂出血急诊手术1例。肿瘤直径1.8～8.7cm,平均4.8cm。采用单纯肾动脉阻断并以吸引器吸除肿瘤的手术方法,观察手术时间、术中出血量、术后住院天数和术中术后并发症及手术效果。结果:20例手术均获得成功,无中转开放手术。平均手术时间119min,19例择期手术患者平均出血量85ml,急诊患者未行肾动脉阻断,术中出血约为1 000ml。平均术后住院时间9.9d。1例术后出现尿瘘,经保守治疗愈合出院。其他患者无围手术期并发症。术后随访3～60个月,无肿瘤复发。结论:后腹腔镜肾错构瘤剜除术应用肾动脉热缺血阻断、介入超声、吸引器吸除肿瘤、术前放置输尿管导管、止血手段等新技术安全可行,具有创伤小、并发症少、恢复快、住院时间短等优点。
Objective: To investigate the surgical technique and clinical effect of retroperitoneal laparoscopic nephron surgery in the treatment of renal hamartoma. Methods: Twenty cases of renal hamartoma were treated by retroperitoneal laparoscopy. Among them, 19 patients underwent elective surgery and one patient was diagnosed as having ruptured hemorrhage due to renal hamartoma. Tumor diameter 1.8 ~ 8.7cm, an average of 4.8cm. Simple renal artery occlusion and aspirator suction and removal of tumor surgical methods, observation of operation time, intraoperative blood loss, postoperative hospital stay and intraoperative and postoperative complications and surgical effects. Results: All the 20 surgeries were successful. There was no transfer to open surgery. The average operation time was 119 minutes. The average bleeding volume of 19 patients undergoing elective surgery was 85ml. The emergency patients were not blocked by renal artery, and the intraoperative bleeding was about 1 000ml. The average postoperative hospital stay 9.9d. One case of urinary fistula occurred after conservative treatment and healing. Other patients without perioperative complications. All cases were followed up for 3 to 60 months without tumor recurrence. Conclusion: Retroperitoneal laparoscopic nephrostomy with renal ischemia and ischemia, interventional ultrasound, aspirator for tumor removal, ureteral catheterization and hemostasis are safe and feasible, with less trauma and complications Less, faster recovery, shorter hospital stay and so on.