扩大分离腰肌前间隙在后腹腔镜肾根治性切除术中的应用

目的优化后腹腔镜肾根治性切除术的手术方法及临床效果。 方法回顾性分析2013年9月至2016年9月我院143例后腹腔镜肾根治性切除术的肾肿瘤患者临床资料,其中65例按常规手术步骤完成手术（对照组）;78例行扩大分离腰肌前间隙（研究组）,判定标准为分离范围：上界至膈肌穹隆顶,下界至肾周筋膜锥尖部,内侧至切开肾蒂腹侧表面肾筋膜,显露疏松网状组织。比较两组手术时间、出血量、围手术期并发症及术后住院时间等。 结果两组患者性别比例、年龄、肿瘤大小、TNM分期等资料差异无统计学意义。对照组和研究组手术时间分别为（95.1±15.1）min和（53.6±20.3）min,术中出血量分别为（80.6±25.6）ml和（45.1±19.7）ml,两组比较差异均存在统计学意义（P<0.05）;术中并发症发生率分别为6.2%（4/65）和1.3%（1/78）,术后肠功能恢复时间（2.1±0.4）d和（2.0±0.4）d,术后住院时间（6.2±1.8）d和（5.7±1.5）d,两组比较差异均无统计学意义（P>0.05）。对照组4例并发症全部为术前未知存在异位动脉,结扎肾血管后创面持续渗血,其中1例迅速分离出异位动脉后切断完成手术,其余3例中转开放手术。研究组1例并发症为气胸,术后胸腔闭式引流3 d后治愈。 结论后腹腔镜肾根治性切除术中扩大分离腰肌前间隙,是对常规手术方法的优化,可缩短手术时间,减少围手术期并发症。

Expanded dissection of prepsoas space in the retroperitoneal laparoscopic radical nephrectomy

ObjectiveTo optimize the surgical procedures and outcomes of retroperitoneal laparoscopic radical nephrectomy. MethodsThe clinical data of 143 patients who underwent retroperitoneal laparoscopic nephrectomy from September 2013 to September 2016 were retrospectively analyzed. The control group (n=65) were performed with routine technique, and the research group (n=78) underwent expanded dissection of prepsoas space. The criteria of dissection range as follow: the upper bound to the diaphragmatic dome, the lower bound to the bottom of Gerota's fascia, and incising the anterior renal fascia until exposing the loose reticular tissue. The mean surgical time, mean blood loss, complication incidence and postoperative hospital stay were compared between the groups. ResultsThere were no differences in gender, age, tumor size, and TNM stage between the two groups (P<0.05). The differences were significant for mean surgical time (95.1±15.1 vs 53.6±20.3) minutes, mean intraoperative blood loss (80.6±25.6 vs 45.1±19.7) ml, between the control group and research group (P>0.05). The differences were not significant in complication incidence (6.2% vs 1.3%), postoperative intestine exhaust time (2.1±0.4 vs 2.0± 0.4) d, duration of hospital stay (6.2±1.8 vs 5.7±1.5) d between the control group and research group (P>0.05). In the control group, 4 cases were found extensive surgical bleeding after ligation of renal blood vessels, due to unknown ectopic artery existing. Among them, 1 case of ectopic artery was quickly isolated and disposed, and then the surgery was completed, the other 3 cases were turned to open surgery. One case was found pneumothorax in research group, who was cured upon thoracic drainage in 3 days. ConclusionThe technique of expanded dissection of prepsoas space in retroperitoneal laparoscopic nephrectomy is the optimization of conventional surgical procedure, which contributes to shorten surgical time and reduce perioperative complications compared with the previous.