一次性腎動靜脈切除法在腹腔鏡腎臟全切除及腎臟輸尿管全切除手術的安全性
黃冠鈞、邱文祥1,2、林文榮、陳建志1,3、楊志東、周永強1、蔡維恭、江百凱、張奐光、林文州、許炯明1、林鼎博、李致樵
馬偕紀念醫院 泌尿科；1馬偕醫學院；2國立陽明大學醫學院；3馬偕醫護管理專科學校
The safety of En-bloc-resection of renal pedicle during laparoscopic nephrecotmy and nephroureterectomy
Kuan-Chun Huang , Allen Wen-Hsiang Chiu1,2, Wun-Rong Lin , Marcelo Chen1,3, Stone Yang, Yung-Chiong Chow1, Wei-Kung Tsai, Pai-Kai Chiang, Huang-Kuang Chang, Wen-Chou Lin, Jong-Ming Hsu1, Ting-Po Lin, Chih-Chiao Lee
Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medical College1, New Taipei City , Taiwan ; School of medicine, National Yang-Ming University2 , Taiwan ; Mackay junior College of Medicine, Nursing, and Management3, New Taipei City
Purpose: As a previous perception, renal hilum en bloc ligation may increase the risk of renal arteriovenous fistula (AVF). We evaluated the safety and effectiveness of en bloc ligation of renal pedicale using endo-gastrointestinal anastomosis stapler(endo-GIA) during laparoscopic nephrecotmy and nephroureterectomy.
Materials and Methods: Medical records were reviewed of 243 patients underwent laparoscopic nephrecotmy and nephroureterectomy from January ,2002 to May ,2015. Preoperative evaluation include estimate blood loss(EBL), operative time(OP time), the method to ligate renal pedicle(en bloc versus separate) are documented. Comparison of EBL and op time are only performed among patients received laparoscopic nephrectomy. Postoperative evaluation include newly diagnosis of heart failure and we also use the CT ( computerized tomography) scan for evaluating the possibility of formation of AVF.
Results: Average age of our patients was 65.42 years (range 12 to 89 yrs) including nephrectomy: 80 patients; nephroureterectomy: 143 patients; nephroureterectomy plus cystectomy: 19 patients. 103 patients have adequate out patient clinic medical records for evaluation and the mean follow-up is 5.3 months(1938.7 days, 15-6033 days). 70 patients have accurate record for the method of renal hilum ligation. (Group A: en bloc, n= 58; Group B: separate, n=12) Among these two groups, there are no significant deference in EBL(p=0.343)and OP time (p=0.635). In our follow up, only 4 patients have newly diagnosis of heart failure. One of them eventually loss follow-up. The rest of 3 patients have no evidence of AVF formation under image and physical examination.
Conclusions: En bloc ligation of renal pedicle during laparoscopic nephrecotmy and nephroureterectomy using endo-GIA is safe with no evidence of AVF formation with average follow up for 5.3 months(longest follow-up for 20 years)