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目的探讨经脐单孔腹腔镜肾部分切除术(laparoendoscopic single-site partial nephrectomy,LESS-PN)治疗早期肾癌的疗效和安全性。方法 2012年11月~2014年2月对10例早期肾癌(T_(1a)N_0M_0)应用自制单孔多通道套管行经脐单孔腹腔镜肾肿瘤部分切除术,阻断肾动脉并计时,距肿瘤边缘1 cm处切除,缝合肾实质,恢复肾血流。结果 10例手术均获成功,肾脏热缺血时间平均19.7 min(15~30 min),手术时间平均93.9 min(80~120 min),术中出血量平均96.4 ml(30~180ml),术中无输血。术后住院平均7.5 d(7~12 d)。术后病理肿瘤切缘均阴性。术后无尿漏、继发出血、感染等并发症。10例术后平均随访12个月(8~16个月),均无瘤生存,未见局部复发及转移。结论 LESS-PN治疗早期肾肿瘤安全可行,但技术要求较高,操作难度较大,需要积累丰富的经验。
Objective To investigate the efficacy and safety of laparoendoscopic single-site partial nephrectomy (LESS-PN) in the treatment of early stage renal cell carcinoma. Methods From November 2012 to February 2014, 10 cases of early stage renal cell carcinoma (T_ (1a) N_0M_0) underwent single-hole laparoscopic partial nephrectomy with a single-hole multi-channel cannula. The renal artery was occluded and time- 1 cm away from the edge of the tumor resection, suture the renal parenchyma, restore renal blood flow. Results All the 10 surgeries were successful. The average time of warm ischemia was 19.7 min (15-30 min), the operation time was 93.9 min (80-120 min) and the mean amount of bleeding was 96.4 ml (30-180 ml) No blood transfusion. The average postoperative hospital stay was 7.5 days (range, 7-12 days). Postoperative pathological tumor margins were negative. Postoperative urine leakage, secondary bleeding, infection and other complications. Ten patients were followed up for an average of 12 months (ranged from 8 to 16 months). All of them had no tumor recurrence and no local recurrence and metastasis. Conclusions LESS-PN is safe and feasible for the treatment of early renal tumors, but it has higher technical requirements and more difficult operation. It requires a wealth of experience.