探讨肾门部囊性肾癌行腹腔镜下肾部分切除术的可行性、安全性及有效性。

回顾性分析海军军医大学附属公利医院、第三附属医院及长征医院2017年1月至2019年12月期间收治的6例应用腹腔镜下肾部分切除术治疗的肾门部囊性肾癌患者的病例资料，收集患者的基线信息，其中男性5例，女性1例，中位年龄45（10）岁，体质量指数23.3（1.5）kg/m²，肿物最大径3.7（0.4）cm，肿瘤R.E.N.A.L.评分8.5（1.0）分；肿瘤分期均为T1期。术前肌酐水平为68（12）μmol/L。术前患肾肾小球率过滤（GFR）47.3（5.5）ml/min，术前血红蛋白水平为138（17）g/L。收集6例患者的手术成功率、中转开放率、手术时间、动脉阻断时间、术中出血量、术后引流管留置天数、术后并发症、术后住院天数、肾功能以及瘤学预后指标，进行统计分析。

6例患者均顺利完成腹腔镜下肾部分切除术，无中转开放手术或改行根治性肾切除术病例。中位手术时间为112（20）min，肾动脉阻断时间为34（7）min，术中出血量为33（22）ml，术后住院时间为6.5（1.0）d。术后无出血、尿漏等围手术期并发症出现，术后病理提示肾恶性肿瘤5例，肾囊性病变1例，切缘阴性。术后3个月中位肌酐为81（12）μmol/L，与术前比较差异无统计学意义（P>0.05），术后3个月患肾GFR为37.0（4.4）ml/min，与术前比较差异有统计学意义（P<0.05），术后中位血红蛋白水平为127（15）g/L，与术前比较差异有统计学意义（P<0.05）。术后3个月随访患者CT检查未见肿瘤复发、转移。

对于肾门部囊性肾癌的病例，在完善各项准备后行腹腔镜下肾部分切除术是可行的，有利于更好的保护肾功能，围手术期疗效确切。

To investigate the feasibility, safety and effectiveness of laparoscopic partial nephrectomy for cystic tumor of the renal hilus.

The data of 6 patients with cystic tumor of renal hilus treated by laparoscopic partial nephrectomy in the three centers from January 2017 to December 2019 were analyzed retrospectively. There were 5 males and 1 females, with a median age of 45(10) years and body mass index of 23.3(1.5) kg/m², maximum tumor diameter 3.7(0.4) cm, the R.E.N.A.L score 8.5(1.0), the tumor stage was T1. The preoperative creatinine level was 68(12) μmol/L. The glomerular filtration rate (GFR) was 47.3(5.5) ml/min. The hemoglobin level was 138(17) g/L. The success rate, opening rate, operation time, artery blocking time, intraoperative bleeding volume, postoperative drainage tube retention days, postoperative complications, postoperative hospital stay days, renal function and tumor prognosis indexes of 6 patients were collected for statistical analysis.

Laparoscopic partial nephrectomy was successfully completed in all patients, and there was no conversion to open surgery or radical nephrectomy. The median operation time was 112(20) min, the renal artery occlusion time was 34(7) min, the intraoperative hemorrhage was 33(22) ml, and the postoperative hospital stay was 6.5(1.0) d. There were no postoperative complications such as bleeding and urinary leakage. Postoperative pathology showed 5 cases of renal malignant tumor and 1 case of renal cyst. The surgical margin was negative. The median creatinine was 81(12) μmol/L in 3 months after operation, which had no significant difference compared with that before operation (P>0.05). The GFR of kidney in 3 months after operation was 37.0(4.4) ml/min, which had significant difference compared with that before operation (P<0.05). The hemoglobin level was 127(15) g/L after operation, and the difference was statistically significant compared with that before operation. After 3 months follow-up, no tumor recurrence or metastasis was found in CT.

Laparoscopic partial nephrectomy is a feasible method for the patients with cystic renal carcinoma in the hilum of kidney, which is beneficial for the better protection of renal function and the exact perioperative effect.