后腹膜返折韧带在后腹腔镜根治性肾切除术中的应用价值

目的探讨后腹腔镜根治性肾切除术中以后腹膜返折韧带作为解剖标志进入肾旁前间隙随患肾切除肾前筋膜的临床可行性及意义。 方法回顾性分析2016年3月至2018年3月期间60例行后腹腔镜根治性肾切除术患者的临床资料，男38例，女22例，平均年龄46岁，肿瘤直径3.8～8.4 cm，平均5.6 cm。术中以后腹膜返折韧带为解剖标志开始手术，第一步进入肾旁前间隙，将肾前筋膜随患肾一并切除。 结果本组60例均顺利完成，将肾前筋膜随患肾切除。平均手术时间55 min，平均术中出血量30 ml，平均下床活动时间15 h，平均术后住院天数6 d。56例患者术后随访6～24个月，平均9个月，均无肿瘤复发。 结论在后腹腔镜根治性肾切除术中，选择后腹膜返折韧带作为解剖标志，可有效辨认后腹膜返折与侧锥筋膜的界限，据此开始手术的第一步，更易分离进入肾旁前间隙随患肾一并切除肾前筋膜，达到该术式要求的在肾周筋膜外游离肾脏的标准，值得在临床推广使用。

The value of superior retroperitoneal fold ligament in retroperitoneal laparoscopic radical nephrectomy

ObjectiveTo investigate the clinical feasibility and value of the superior retroperitoneal fold ligament as the marker to enter anterior pararenal space and remove prerenal fascia as the first step for retroperitoneal laparoscopic radical nephrectomy. MethodsThe clinical data of 60 patients (male:n=38, female:n=22, average age=46 years, the diameter of tumor=3.8-8.4 cm, average=5.6 cm) who underwent retroperitoneal laparoscopic radical nephrectomy from March 2016 to March 2018 were retrospectively analyzed. The first step of the operation used the superior retroperitoneal fold ligament as the marker to enter anterior pararenal space in order to remove prerenal fascia with the kidney. ResultsAll the operations were performed successfully by removing prerenal fascia with the kidney. The average operation time was 55 min, the average blood loss was 30 ml, the had been average ambulation time was 15 hours, the average postoperative hospital stay was 6 days. 56 cases had been followed up for 9(6-24) months, no local recurrence of tumor was found. ConclusionsUsing superior retroperitoneal fold ligament as the marker in the first step of retroperitoneal laparoscopic radical nephrectomy can efficiently identify the border between retroperitoneal fold and lateral conal fascia, which will make it easier to enter anterior pararenal space and remove prerenal fascia for meeting the standards of radical nephrectomy. It is worth popularizing in clinical practice.