后腹腔镜根治性肾切除术的临床应用

目的探讨后腹腔镜根治性肾切除术的可行性、安全性及临床疗效。方法2003年3月至2008年2月行后腹腔镜根治性肾切除术52例。男29例,女23例。年龄24～78岁,平均年龄57岁。右侧27例,左侧25例。无痛性全程肉眼血尿8例,其余44例为超声体检发现。肿瘤的大小1.5cm×1.8cm～8.7cm×9.2cm,平均3.6cm×4.3cm。肿瘤位于肾上极19例,肾中部15例,肾下极18例。52例均行CT检查,19例行MRI检查。术前临床分期：T1N0M05例,T2N0M045例,T3aN0M02例。结果52例均获成功,无中转开放手术患者,有13例腹膜破裂,有6例术后肩部隐痛,有4例切口皮下气肿,患者均在短期恢复。术后均无使用镇痛剂。手术时间90～230min,平均152min;出血量50～200ml,平均120ml;术后住院时间6～9d,平均7.5d。术后病理报告：肾透明细胞癌49例,囊性肾细胞癌2例,肾颗粒细胞癌1例。随访6～36个月,平均15个月,未见肿瘤复发。结论后腹腔镜根治性肾切除术安全可行、疗效肯定。

The clinical application of retroperitoneal laparoscopic radical nephrectomy

Objective To explore the feasibility,safety and clinical effect of retroperitoneal laparoscopic radical nephrectomy.Methods 52 patients（29 males,23 females） with mean age of 57 years range（24-78 years） underwent retroperitoneal laparoscopic radical nephrectomy from march 2003 to february 2008.27 cases located in the right and 25 cases located in the left.8 cases were painless whole course gross hematuria,and other 44 cases were found by ultrasonic physical examination.The tumor size ranged form 1.5 cm×1.8 cm to 8.7 cm×9.2 cm mean（3.6 cm×4.3 cm） 19 cases located in the upper role of kidney,15 cases located in the middle role of kidney,18 cases located in the lower role of kidney.52 cases were all by CT scanand 19 cases were by MRI scan.Preoperative clinical staging：5 cases were T1N0M0,45 cases were T2N0M0 and 2 cases were T3aN0M0.Results Success had been achieved in all cases and no patient conversions to open surgery.13 cases had peritoneum rupture,6 cases had dull pain in shoulder postoperative and 4 cases had subcutaneous emphysema in incision.The patients were all recovery in short time.Postoperative there were no use analgesics.The operative time ranged from 90 to 230 minutes mean（152 minutes） bleeding volume ranged from 50 to 200 ml mean（120 ml） Postoperative hospital stay ranged from 6 to 9 days mean（7.5 days） Postoperative pathological reports：49 cases were renal clear cell carcinoma,2 cases were cystic renal cell carcinoma,1 case was renal granular carcinoma.No tumor recurrence had been observed during the 6-36 months mean（15 months） follow up.Conclusions Retroperitoneal laparoscopic radical nephrectomy is safe,feasible and definite effect.