后腹腔镜下肾切除术的关键——肾蒂处理的体会

目的总结后腹腔镜下肾切除术中肾蒂处理的经验。方法根治性肾切除术66例,单纯性肾切除术52例,活体供肾切取术2例,术中注意肾蒂的快速寻找、及早控制和适当的处理方法三要点。结果116例后腹腔镜手术成功,4例中转开放手术。手术时间65～180min,平均103min。术中出血量50～150ml,平均70ml,病人均未输血。术后2～3d拔除引流管,3～5d下床活动,恢复顺利,无并发症。105例随访2年未发现异常。结论肾蒂快速寻找、及早控制和适当的处理方法是后腹腔镜下肾脏切除手术成功的关键。

Experience on Retroperitoneal Laparoscopic Nephrectomy

Objective To discuss the key points of retroperitoneal laparoscopic nephrectomy. Methods Totally 120 patients with renal tumor or non-functional kidney underwent retroperitoneal laparoscopic nephrectomy in our center. Among the cases, radically nephrectomy was performed on 66 patients, simple nephrectomy was carried out in 52, and live donor nephrectomy was made in the other 2. Results In this series, the operation time ranged from 65 to 180 minutes （mean, 103 min）, and the mean intraoperative bleeding volume was 70 ml （range, 50 to 150 ml）. No case was given blood transfusion and the drainage tube was removed in 2 to 3 days after the surgery. At days 3 to 5, all the patients recovered normal activity without complications. Of the cases, 105 achieved a follow-up for 2 years, none of them showed abnormality. Conclusion Quick exploration and early control of the renal pedicle, and proper management are the key points for retroperitoneal laparoscopic nephrectomy.