精准解剖性后腹腔镜技术在肾和肾上腺占位性病变中的应用

目的 探讨精准解剖性后腹腔镜技术在肾和肾上腺占位性疾病中的临床应用价值。方法 回顾性分析2014年6月—2016年12月蚌埠医学院第一附属医院泌尿外科收治的43例精准解剖性后腹腔镜手术治疗的肾和肾上腺占位性疾病患者临床资料,其中男23例、女20例,年龄(39.8±18.7)岁;肾上腺肿瘤16例,肾肿瘤19例,肾囊肿8例。患者均采用精准解剖性后腹腔镜技术行无血管层面准确分离及肾上腺肿瘤切除术或根治性肾切除术或肾囊肿去顶减压术。观察术中失血量、手术时间、手术并发症、术后引流管留置时间、住院时间及随访情况。结果 43例手术均获成功,无中转开放手术,术中无明显并发症发生;术后无漏尿和腹膜后感染,无肠梗阻和肾功能不全,无围手术期死亡病例。肾上腺肿瘤切除手术时间、术中出血量、引流管留置时间和术后住院时间平均分别是35 min、15 mL、(3.2±0.6)d和(4.8±1.6)d,肾肿瘤根治切除术分别是72 min、90 mL、(3.8±0.7)d和(6.5±2.4)d,肾囊肿去顶减压术分别是25 min、10 mL、(2.5±0.5)d和(4.2±1.3)d。肾脏肿瘤术后病理肾嫌色细胞癌2例,肾乳头状细胞癌3例,肾透明细胞癌14例;肾上腺肿瘤术后病理均为良性腺瘤。所有患者术后随访12~30个月,未见肿瘤局部复发或远处转移。结论 精准解剖性后腹腔镜技术在治疗肾和肾上腺占位性病变中选择无血管解剖平面操作,出血少、视野清、创伤小,并发症少,有助于手术规范化、标准化,利于初学者学习和技术的快速推广。

Application of precise anatomical retroperitoneoscopic technology in kidney and adrenal gland diseases

Objective To summarize clinical application values of precise anatomical retroperitoneoscopic technology in kidney and adrenal gland diseases.Methods Forty-three patients with the occupation lesions of the renal or adrenal were enrolled in this study, including 23 males and 20 females with the age of (39.8±18.7)years old. Among them, adrenal tumor 16 patients, renal tumor 19 patients,renal cyst 8 patients. All patients underwent precise anatomical retroperitoneoscopic operation, retroperitoneal laparoscopic adrenalectomy or retroperitoneal laparoscopic radical nephrectomy or retroperitoneal laparoscopic renal cyst decompression. The intraoperative blood loss, operation time, complications, indwelling time of drainage tube, hospitalization time and follow-up data were observed.Results All the operations were successful with no case transferred to open operation. No complications occurred, no leakage of urine and retroperitoneal infection, no intestinal obstruction and renal insufficiency, no perioperative death. The mean operation time, intraoperative bleeding volume, indwelling time of drainage tube and postoperative hospitalization time of retroperitoneal laparoscopic adrenalectomy were 35 minutes, 15 mL, (3.2±0.6) d and (4.8±1.6) d respectively. Retroperitoneal laparoscopic radical nephrectomy were 72 minutes, 90 mL, (3.8±0.7) d and (6.5±2.4) d, and retroperitoneal laparoscopic renal cyst decompression were 25 minutes and 10 mL, (2.5±0.5)d and (4.2±1.3) d. Postoperative pathology of renal masses included 2 patients of renal chromophobe cell carcinoma,3 patients of papillary renal cell carcinoma,and 14 patients of clear cell renal cell carcinoma. Postoperative adrenal tumors were benign adenomas.All patients were followed up for 12-30 months after surgery, no local recurrence or distant metastasis.Conclusions Precise anatomic retroperitoneal laparoscopic surgery can reduce bleeding, with clear vision, small trauma and low complication rate for kidney and adrenal gland diseases. It is helpful to normalize and standardize the operation, which is easy to learn for the beginners and helpful for rapid popularization of technology.