解剖性后腹腔镜根治性肾切除术快速寻找并处理肾蒂体会

目的:探讨解剖性后腹腔镜根治性肾切除术快速寻找并处理肾蒂技巧。方法:后腹腔镜根治性肾切除43例，根据肾蒂寻找和处理方式不同，分为2组。对照组21例采用传统后腹腔镜根治性肾切除术，于肾脏背侧肾门隆起处寻找肾蒂；观察组22例行解剖性后腹腔镜根治性肾切除术，沿下腔静脉表面（右侧）或腹主动脉表面（左侧）寻找肾蒂。比较2组肾蒂寻找并处理时间、术中出血量、手术时间、术中及术后并发症发生率、淋巴结清扫数量、引流管拔出时间及术后住院时间。结果:43例手术均获成功，无中转开放手术。观察组肾蒂寻找并处理时间明显短于对照组（P<0.01），淋巴结清扫数量多于对照组（P<0.05）；2组术中及术后均无严重并发症发生，2组术中出血量、手术时间、术后引流管拔出时间和术后住院时间差异均无统计学意义（P>0.05）。结论:解剖性后腹腔镜根治性肾切除术采用下腔静脉或腹主动脉表面法寻找并处理肾蒂，解剖层面清晰，操作视野好，可快速寻找并处理肾蒂血管，并提高淋巴结清扫数量，有助于手术规范化、标准化及技术快速推广。

Experience of fast locating and ligating renal pedicle in anatomical retroperitoneal laparoscopic radical nephrectomy

Objective:To explore the experience of fast locating and ligating renal pedicle in anatomical retroperitoneal laparoscopic radical nephrectomy.Methods:Forty-three patients treated with retroperitoneal laparoscopic radical nephrectomy were divided into the control group(21 cases) and observation group(22 cases) according to the different ways of locating and ligating the renal pedicle.The control group were treated with retroperitoneal laparoscopic radical nephrectomy,and the renal pedicle were located at the protuberance of renal dorsal side.The observation group were treated with anatomical retroperitoneal laparoscopic radical nephrectomy,and the renal pedicle were looked for along the surface of the inferior vena cava(right side) or abdominal aorta(left side).The time of locating and ligating renal pedicle,intraoperative bleeding volume,operation time,incidence rate of intraoperative and postoperative complications,number of lymph node dissected,extracting drainage tube time and postoperative hospital stay were compared between two groups.Results:All operations were successful,and no case was open operated.The time of locating and ligating renal pedicle in observation group was significantly shorter than that in control group(P<0.01),and the number of dissecting lymph node in observation group were more than that in control group(P<0.05).There was not serious complications in two groups during perioperative and postioperative period.The differences in bleeding volume,operation time,extracting drainage tube time and postoperative hospitalization time between two groups were not statistically significant(P>0.05).Conclusions:Anatomical retroperitoneal laparoscopic radical nephrectomy combined with looking for renal pedicle along the surface of the inferior vena cava or abdominal aorta can quickly locate and ligate renal pedicle vessels and improve the number of dissecting lymph node,and the anatomy and operation vision are clear.It is helpful for standardization of surgery and rapid popularization of technology.