后腹腔镜下解剖性根治性肾切除术168例

目的 介绍后腹腔镜下解剖性根治性肾切除术的手术方法及临床效果. 方法对168例肾癌患者实施后腹腔镜下解剖性根治性.肾切除术.肿瘤位于左肾87例,右肾81例.肿瘤直径2.0～6.9 cm,平均4.7 cm.T1.N0M0 92例,T10N0M0.76例.常规制备后腹腔间隙.按顺序分别进入4个相对无血管解部层面进行分离.第一分离层面位于腰肌前间隙,此层面可以在手术初期快速找到肾蒂;第__二分离层面位于Gerota筋膜前叶与融合筋膜之间;第三分离层面位于肾上腺与肾上极之间或膈肌与肾上腺间隙;第四分离层面位丁Gerota筋膜的锥尖部. 结果 168例手术均成功完成,平均手术时间(138±46)min,平均术中出血量(90±30)ml.恢复饮食和下床活动时间分别为1.3 d和1.2 d.术后平均住院日5.8 d.14例发生腹膜破口,未影响手术进行.18例术后有不同程度肩痈,2 d后自行消失.123例随访6～18个月,平均8个月,均无瘤生存. 结论 后腹腔镜下解削性根治性肾切除术具有解剖层次清楚、术中出血少、术野清晰、疗效确切、并发症少、恢复快等优点,为需要根治性肾切除术的患者提供了更好的选择.

Technique of retroperitoneoscopic anatomical radical nephrectomy

Objective To introduce the technique and evaluate the clinical effect of retroperito-neoscopic anatomical radical nephrectomy. Methods One hundred and sixty-eight patients under-went retroperitoneoscopic anatomical radical nephrectomies. The average tumor size was 4.7 cm (ran-ging from 2.0-6.9 era) in diameter. There were 87 tumors in the left kidney and 81 tumors in right kidney. Ninety-two eases were in cli.nieal stage T1a. N0 M0 and 76 in T1b N0 M0. Retroperitoneal space was created routinely at lateral decubitus position. Four relatively bloodless planes were orderly entered for exposure and separation of the kidney outside Gerota's fascia. The first dissection plane was be-tween the psoas and posterior Gerota's fascia. The renal pedicle was found in this plane. The following dissections proceeded in the plane between posterior Gerota's fascia and fusion fascia. The third dissec-tion plane was between adrenal gland and the upper pole of kidney or between the adrenal gland and di-aphragma. The fourth dissection plane was in the bottom of Gerota's fascia. Results All operations were successfully completed. The mean operative time was 138:J:46 min and estimated blood loss was 90±30 ml. The average day of resuming oral intake was 1.3 d and time of ambulation was 1.2 d. The mean postoperative hospital stay was 5.8 d. Peritoneum injuries happened in 14 patients. Omalgia oc-curred in 18 patients and disappeared 2 d after operation. One hundred and twenty-three patients were followed up, they all survived during the average follow-up of 8 months (ranging from 6-18 months);, .Conclusions Retroperitoneoscopie anatomical radical nephrectomy is a safe and effective procedure. It can decrease operation time, blood loss and complication rate remarkably. It is a good option for patients needing radical nephrectomy.