Clinical application of laparoscopic mushroom shaped enucleation in the treatment of ectopic renal angiomyolipoma

doi:10.3877/cma.j.issn.1674-6899.2020.04.006

Abstract

Abstract:

Objective

To compare the safety and efficacy of laparoscopic "mushroom" enucleation and standard partial nephrectomy for ectopic renal angiomyolipoma, so as to provide clinical basis for the establishment of laparoscopic "mushroom" enucleation of renal angiomyolipoma.

Methods

From Jan.2018 to May 2019, 53 patients with renal angiomyolipoma underwent laparoscopic surgery in the Second Affiliated Hospital of Hainan Medical College and the Chinese PLA General Hospital. Among them, 25 cases underwent mushroom shaped enucleation along the pseudocapsule of the tumor (group A), 28 cases underwent partial nephrectomy (group B). The changes of renal artery occlusion time, operation time, intraoperative blood loss, preoperative and postoperative hemoglobin and eGFR (estimated glomerular filtration rate) were compared between the two groups.

Results

53 cases of operation were not converted to open, no death cases. renal artery occlusion time: (11.9 ± 2.2)min in group A. (21.5 ± 6.5)min in group B(P< 0.001). Operation time: ( 87.9 ± 24.8) min in group A. (114.3 ± 38.9) min in group B(P< 0.001). Intraoperative blood loss: group A: 20 ml(20-40)ml. group B: 50 ml(50-100)ml(P< 0.001). The change of hemoglobin 24 hours after operation: group A: (7.4±4.3)g/L. group B: (12.4±8.8)g/L(P=0.013). 24 hours after operation, the change of eGFR was (6.2 ± 7.2) ml (min·1.73 m²) in group A, (12.7 ± 12.8) ml (min·1.73 m²) in group B(P= 0.027). The change of eGFR in group A was (1.5 ± 3.7)ml(min·1.73 m²), and in group B was( 6.5 ± 5.6) ml(min·1.73 m²)(P< 0.001). Postoperative hospitalization days, group A: 4.0(3-4)days; group B: 4.5(3-6)days(P= 0.023). Postoperative follow-up: there was no recurrence in both groups.

Conclusions

Laparoscopic "mushroom" enucleation for ectopic renal angiomyolipoma was superior to traditional partial nephrectomy in terms of renal artery occlusion time, intraoperative blood loss, changes of hemoglobin and eGFR, and length of hospital stay. There was no recurrence of tumor in both groups. This method is safe and effective and suitable for clinical application.

Key words: Renal angiomyolipoma, Laparoscopic, Enucleation of renal tumor, Partial nephrectomy

Daqing Zhu, Gang Guo, Xue Shao, Liangyou Gu, Yi Wang. Clinical application of laparoscopic mushroom shaped enucleation in the treatment of ectopic renal angiomyolipoma[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2020, 13(04): 218-222.

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Figures/Tables 6

References 18

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组别	例数	性别[例(%)]		年龄(岁， ±s)	侧别[例(%)]		肿瘤直径(cm， ±s)
组别	例数	男	女	年龄(岁， ±s)	左	右	瘤冠	基底部
"蘑菇状"剜除组	25	3(12.0)	22(88.0)	45.2±14.5	14(56.0)	11(44.0)	5.4±1.7	2.4±0.9
肾部分切除组	28	5(17.8)	23(82.2)	45.8±12.9	12(42.8)	16(57.2)	5.9±1.3	2.4±1.0
P值	?	0.708	0.885	0.414	?	0.301	0.993	?

组别	例数	性别[例(%)]		年龄(岁， ±s)	侧别[例(%)]		肿瘤直径(cm， ±s)
组别	例数	男	女	年龄(岁， ±s)	左	右	瘤冠	基底部
"蘑菇状"剜除组	25	3(12.0)	22(88.0)	45.2±14.5	14(56.0)	11(44.0)	5.4±1.7	2.4±0.9
肾部分切除组	28	5(17.8)	23(82.2)	45.8±12.9	12(42.8)	16(57.2)	5.9±1.3	2.4±1.0
P值	?	0.708	0.885	0.414	?	0.301	0.993	?

项目	"蘑菇状"剜除组(25例)	肾部分切除组(28例)	P值
手术时间(min， ±s)	87.9±24.8	114.3±38.9	<0.001
术中肾动脉阻断时间(min， ±s)	11.9±2.2	21.5±6.5	<0.001
术中出血量[ml，中位数(四分位间距)]	20(20～40)	50(50～100)	<0.001
术后住院时间[d，中位数(四分位间距)]	4.0(3～4)	4.5(3～6)	0.023
术后24 h血红蛋白(g/L， ±s)	7.4±4.3	12.4±8.8	0.013
术后24 h eGFR [ml(min·1.73 m²)， ±s]	6.2±7.2	12.7±12.8	0.027
术后6个月eGFR[ml(min·1.73 m²)， ±s]	1.5±3.7	6.5±5.6	<0.001

项目	"蘑菇状"剜除组(25例)	肾部分切除组(28例)	P值
手术时间(min， ±s)	87.9±24.8	114.3±38.9	<0.001
术中肾动脉阻断时间(min， ±s)	11.9±2.2	21.5±6.5	<0.001
术中出血量[ml，中位数(四分位间距)]	20(20～40)	50(50～100)	<0.001
术后住院时间[d，中位数(四分位间距)]	4.0(3～4)	4.5(3～6)	0.023
术后24 h血红蛋白(g/L， ±s)	7.4±4.3	12.4±8.8	0.013
术后24 h eGFR [ml(min·1.73 m²)， ±s]	6.2±7.2	12.7±12.8	0.027
术后6个月eGFR[ml(min·1.73 m²)， ±s]	1.5±3.7	6.5±5.6	<0.001

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