背景:在此案例报告中,我们展示了我们的后腹腔镜下马蹄肾T1b右肺门肿瘤切除术的技术。
方法:一名77岁的越南妇女因右侧腹部疼痛被送往医院。在介绍时,她的血清肌酐为0.86mg/dL,肾小球滤过率为65.2mL/min/1.73m2.根据她的肾闪烁显像,右侧和左侧部分的肾小球滤过率分别为24.2和35.5mL/分钟,分别。计算机断层扫描成像显示5.5×5.0cm实性肺门肿块,cT1bN0M0肿瘤分期正确。经过讨论,患者选择了微创手术来治疗她的恶性肿瘤。患者被置于侧腹位置。我们使用高尔的气球技术创造了腹膜后工作空间,计划使用四个套管针端口。解剖了三条动脉,包括两条供血正确部分的动脉,一条供血于峡部的动脉,和一条静脉,被Hem-o-lok剪裁和分割。使用内窥镜进行峡部切除术。因此,输尿管被夹住并分开。最后,马蹄肾的整个右段被动员起来,并通过侧腹切口取出。
结果:总手术时间为250分钟,估计失血量为200mL。患者术后血清肌酐为1.08mg/dL,肾小球滤过率为49.47mL/min/1.73m2。患者在术后第4天出院,无并发症。肿瘤标本的最终病理检查显示FuhrmanII级透明细胞肾细胞癌,囊侵犯,手术切缘阴性。经过三个月的随访,血清肌酐为0.95mg/dL,肾小球滤过率为57.7mL/min/1.73m2。随访计算机断层扫描成像未发现局部复发或转移。
结论:腹膜后腹腔镜肾细胞癌切除术对于马蹄形肾细胞癌患者是一种安全可行的技术,在没有使用机器人技术的低收入环境中可能特别有用。
BACKGROUND: In this
case report, we demonstrate our technique of a retroperitoneal laparoscopic heminephrectomy for a T1b right hilar tumor in a horseshoe kidney.
METHODS: A 77-year-old Vietnamese woman presented to the hospital because of right flank pain. On presentation, her serum creatinine was 0.86 mg/dL and glomerular filtration rate was 65.2 mL/minute/1.73 m2. According to her renal scintigraphy, glomerular filtration rates of the right and left moieties were 24.2 and 35.5 mL/minute, respectively. Computed tomography imaging demonstrated a 5.5 × 5.0 cm solid hilar mass with a cT1bN0M0 tumor stage was in the right moiety. After discussion, the patient elected a minimally invasive surgery to treat her malignancy. The patient was placed in a flank position. We used Gaur\'s balloon technique to create the retroperitoneal working space, and four trocar ports were planned for operation. Three arteries were dissected, including two arteries feeding the right moiety, one artery feeding the isthmus, and one vein, which was clipped and divided by Hem-o-lok. The isthmusectomy was performed with an Endostapler. Consequently, the ureter was clipped and divided. Finally, the whole right segment of the horseshoe kidney was mobilized and taken out via the flank incision.
RESULTS: The total operative time was 250 min with an estimated blood loss of 200 mL. The patient\'s serum creatinine after surgery was 1.08 mg/dL, and glomerular filtration rate was 49.47 mL/minute/1.73 m2. The patient was discharged on postoperative day #4 without complication. Final pathologic examination of the tumor specimen revealed a Fuhrman grade II clear cell renal cell carcinoma, capsular invasion, with negative surgical margins. After a three-month follow-up, the serum creatinine was 0.95 mg/dL, and glomerular filtration rate was 57.7 mL/minute/1.73 m2. Local recurrence or metastasis was not detected by follow-up computed tomography imaging.
CONCLUSIONS: Retroperitoneal laparoscopic heminephrectomy is a safe and feasible technique for patients with renal cell carcinoma in a horseshoe kidney and may be particularly useful in low income settings without access to robotic technology.