ABSTRACT
Objective: Retro-laparoscopic partial nephrectomy is a challenge for ventro-renal tumors, especially hilar tumors.The tumors are partial or entirely out of operative field and there is blind space for operation.To solve this problem, a set of techniques including renal pedicle rotation is developed.Methods: A set of techniques including renal pedicle rotation, double-layer suture, early artery unclamping for retro-laparoscopic nephrectomy for ventro-renal tumors, especially hilar tumors were developed.Hilar tumors were located anteriorly to the angle of the renal and renal arteries and in contact with the anterior surface of the renal artery.The evaluation of the outcomes included the operation time, warm ischemia time, estimated haemorrhage, surgical margin, renal function after operation, and complications.This study reviewed the data of 28 patients with ventro-renal tumor, including 15 patients with complex hilar tumors.Results: The average tumor size was (3.8±0.5) cm.The average R.E.N.A.L score was 8 (ranging from 7 to 9).The average warm ischemia time was (23.8±4.7) min, and suture time was (26.2±6.5) min, and operation time was (124.1±12.1) min.The median hospital stay was 4 days and the average estimated haemorrhage was (139.1±54.0) mL.All the surgeries were operated under laparoscope and no surgery switched to open surgery.Seven patients developed Clavien Dindo Ⅰ-Ⅱ complications after operation.Three patients (10.7%) developed collective system damage and received repair of collective system in time and three patients (10.7%) developed slightly gross hematuria (Clavien-DindoⅠ).Two patients developed wound infection (Clavien-DindⅡ).Three patients (10.7%) got renal vein clamped because of capillary hemorrhage from basilar part of tumors.There were 14 patients received early unclamping of renal artery, and no obvious renal vessel damage was found.There were statistically significant differences between the serum creatinine levels (P<0.05) and the estimated glomerular filtration rates (P=0.02) before and after surgery.All the patients'' serum creatinine levels were in normal range and no patient needed regular dialysis.There was no positive surgical margin and the median follow-up was 7 months without local recurrence or distant metastasis.Conclusion: It is safe and effective to apply renal pedicle rotation technique in retro-laparoscopic partial nephrectomy for ventro-renal tumors.The short-term follow-up results are optimistic, but long follow-up is required.
ABSTRACT
Objective:To evaluate the effect of surgery on 47 patients with moyamoya disease by retrospective analysis.Methods:A total of 47 patients with moyamoya disease were enrolled from August,2010 to According to the improved treatment in August,2013,all cases were divided into two groups:a pre-improved group and a post-improved group.According to different surgical methods,they were divided into two subgroups:an indirect revascularization subgroup and a combined revascularization subgroup.Results:The cerebral ischemia in 77.4％ of patients was relieved after the surgery.There was significant difference in outcomes of patients between the pre-improved group and the post-improved group (P＜0.05),while there was no significant difference between the pre-improved indirect revascularization subgroup and the pre-improved combined revascularization subgroup.There was also no significant difference between the post-improved indirect revascularization subgroup and the post-improved combined revascularization subgroups (P＞0.05).Conclusion:Surgical treatment can improve the outcomes of patients with moyamoya disease,but there is no significant difference in surgical effects between indirect and combined revascularization.