目的 探讨T1a期肾细胞癌行腹腔镜下肾部分切除术的可行性及临床疗效.方法 选择83例T1a期肾细胞癌患者行腹腔镜下肾部分切除术.肾动脉阻断,距肿瘤约0.5 cm处,整块剪除肿瘤和部分肾实质及其表面的脂肪组织,分层缝合集合系统和肾实质,解除肾动脉阻断.观察手术时间、肾动脉阻断时间、术中出血量、术后并发症、肾功能、临床复发及转移情况.结果 83例患者中2例因术中出血中转开放手术,其他病例均顺利完成腹腔镜手术.手术时间90～120 min,平均105 min;热缺血时间25～40 min,平均30 min;术中出血40～120 ml,均未输血.随访10～36个月,平均23个月,无继发出血,无漏尿,无肿瘤局部复发及远处转移,肾功能无异常.结论 腹腔镜下肾部分切除术治疗T1a期肾细胞癌安全可行.%Objective To investigate the feasibility and clinical efficacy of laparoscopic partial nephrectomy for T la renal cell carcinoma. Methods 83 cases of Tla renal cell carcinoma underwent laparoscopic partial nephrectomy . Renal artery occlusion, lifting from the tumor about 0. 5 cm block cut off the fatty tissue of the tumor and part of the renal paren -chyma its surface, layered suture collection system and renal parenchyma , renal artery occlusion. The operation time, blood loss, postoperative complications , renal function, clinical relapse and metastasis of renal artery occlusion were ob -served. Results Among the 83 cases, laparascopic operation was successfully performed in 81 cases except 2 cases, which were converted to open surgery due to blood loss during the lapaparscopic operation . The mean operation time was 105 min (range, 90-120 min) and the mean warm ischemia time was 30 min (range, 25 -40 min). The blood loss was 40 -120 ml, no blood transfusion. An average of 23 months of follow -up (range, 10 -36 months) showed no secondary bleeding, no leakage of urine, no local tumor recurrence and distant metastasis , and no abnormal renal function. Conclusion Laparoscopic partial nephrectomy surgery for T la renal cell carcinoma is feasible and safe.
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