关键词: 零缺血, 免缝合, 腹腔镜肾部分切除术, 铥激光, 局限性肾癌

Abstract: Objective To investigate the safety and efficacy of zero-ischemia and sutureless laparoscopic partial nephrectomy using thulium laser for the treatment of localized renal cell carcinoma.Methods A retrospective analysis was performed on the clinical data of 28 patients with localized renal cell carcinoma admitted to our hospital from January 2020 to March 2023.Laparoscopic zero-ischemia suturing thulium laser partial nephrectomy was adopted.The surgical data,postoperative changes in renal function,perioperative complications,and prognosis were analyzed.Results Three patients underwent traditional partial nephrectomy immediately by blocking the renal arteries during the operation due to poor hemostasis.The remaining 25 patients successfully completed zero ischemia and sutureless laparoscopic partial nephrectomy using thulium laser,without intraoperative blood transfusion or open surgery.The surgical time ranged from 85 to 135 min,with an average of (108.4±14.7) min，the estimated blood loss was 50-250 ml,with an average of (117.7±51.7)ml.The drainage tube was removed 4-7 days postoperative,with an average of(5.6±0.9)days.The postoperative hospital day was 6～10 days,with an average of (7.7±0.9)days.There were no severe complications such as urinary fistula or secondary bleeding occurred.Preoperative serum creatinine was 60.4-116.0 μmol/L,with an average of (74.0±20.5)μmol/L.One week after the operation,the creatinine was 58.6-120.8 μmol/L,with an average of  (73.5±21.8)μmol/L,which was not significant compared with that before surgery (P>0.05).Postoperative pathology revealed 23 cases of clear cell renal cell carcinoma,4 cases of papillary renal cell carcinoma,and 1 case of chromophobe cell carcinoma.All cases was shown negative margins and there was no recurrence or metastasis during a follow-up period of 12 to 24 months.
Conclusion Zero-ischemia and sutureless laparoscopic partial nephrectomy using thulium laser can better preserve kidney function without ischemia reperfusion injury.It is a safe and feasible surgical option for patients with localized renal cell carcinoma.

Key words: zero ischemia；sutureless, laparoscopic partial nephrectomy；thulium laser；localized renal cell carcinoma