后腹腔镜保留肾单位手术术式对术肾肾功能的影响

目的：探讨后腹腔镜保留肾单位手术（LNSS）术式对术肾肾功能的影响。方法：2009年1月-2010年12月行经后腹膜途径腹腔镜保留肾单位手术例26。男16例,女10例。随访时间〉1年的有18例。年龄40-70岁。肾细胞癌23例,肾嫌色细胞癌2例,肾平滑肌瘤1例。肿瘤直径2.6-3.2cm,平均2.9cm。所有患者术中阻断肾动脉,剪刀切除肿瘤。术中肾动脉阻断时间20-30min,平均26.4分钟。分别于术前、术后2周、术后3月、术后1年测定双肾显像、血清肌酐、血清胱抑素。结果：18例患者术肾术前GFR及占总GFR的比例分别为53.2±7.8 ml/min和50.7±3.6%,术后两周GFR及占总GFR的比例分别为31.2±8.9 ml/min和35.8±5.8%,术后3月GFR及占总GFR的比例分别为34.7±8.6 ml/min和38.4±5.3%,术后1年GFR及占总GFR的比例分别为41.1±9.7 ml/min和43.2±6.2%。血清肌酐及血清胱抑素术前术后对比因为受对侧肾功能的影响不能反映对分肾功能的影响。结论：LNSS术式对于直径小于4cm的肾早期肿瘤是切实可行的。

Impact of posterior laparoscope nephron sparing surgery on renal function after kidney surgery

Objective： Research the impact of posterior laparoscope nephron sparing surgery（LNSS） to the diseased kidney renal function.Methods：A total of 26 kidney neoplasms cases（40-70 years old） included 15 men and 11 women received LNSS from January 2009 to December 2010 in our hospital and 20 cases were followed over one year.25 cases is diagnosed clear cell carcinoma of kidney,1case is diagnosed leiomyoma of kidney.The diameter of tumors is 2.6-3.2 centimeters（mean 2.9 centimeters）.All the patient need to be obstructed renal artery with hilar clamping.The time thant renal artery was obstructed about 20-30 minute（mean 26.4min）.Renal scintigraphy,serum creatinine and serum cystatin would be measured before surgery,2 weeks,3 months and 1year post-surgery.Results：Median GFR was 53.2 ml/min,31.2 ml/min,34.7 ml/min and 41.1 ml/min before surgery,2 weeks,3 months and 1 year after LNSS.Median contribution of the affected kidney to total renal function was 50.7 %,35.8%.38.4% and 43.2% after LNSS.Conclusion：LNSS can be applied on the patient with renal tumor smaller than 4cm.