经腹腹腔镜处理大体积肾癌81例的临床疗效与经验

目的]总结经腹腹腔镜处理大体积肾癌（＞7 cm ）的临床经验。方法]回顾性分析我院2009年10月至2012年12月经腹腹腔镜治疗的大体积肾癌81例临床资料，总结围手术期并发症及相关预后情况。结果]81例患者手术时间70～220 min ，平均127 min ，术中评估出血量50～800 mL ，平均150 mL。2例（2．5％）手术中转开放治疗，4例（4．9％）患者接受了输血治疗，无肠梗阻、腹腔感染及淋巴漏发生。术后随访6～44个月，平均随访28．3个月，4例（4．9％）出现肺转移；3例（3．7％）出现术区局部复发；1例（1．2％）出现肝脏及腹腔多发转移；1例（1．2％）出现骨转移，其余患者未发现肿瘤复发及转移。结论]经腹腹腔镜处理大体积肾癌是一种安全可行的手术方式，有腹腔脏器损伤导致中转开放手术的风险，应谨慎选择。

Clinical Efficacy and Experience of Transperitoneal Laparoscopic Radical Nephrectomy for 81 Cases of Large Mass Renal Cell Carcinoma

Objective]To summarize clinical experience of transperitoneal laparoscopic radical nephrectomy for large mass renal cell carcinoma （RCC ,〉7cm） .Methods]Clinical data of 81 patients with large mass RCC undergoing tranperitoneal laparoscopic radical nephrectomy in our hospital from Oct .2009 to Dec .2012 were analyzed retrospectively .Perioperative complications and the prognosis of patients were summarized .Re-sults]The mean operative time of 81 patients was 127min （70~220min） and the mean estimated blood loss was 150ml（50~800 ml） .Two Patients（2 .5% ） were converted to open surgery and four patients （4 .9% ） received blood transfusion .No intestinal obstruction ,abdominal infection and lymph leakage occurred .The mean fol-low-up was 28 .3 months（6~44 months） .Four patients （4 .9% ） developed pulmonary metastasis ,and 3 pa-tients（3 .7% ） developed local recurrence ,and one patient（1 .2% ） presented hepatic and peritoneal metastasis , and one patient（1 .2% ） developed bone metastasis .The remaining patients showed no tumor recurrence and metastasis .Conclusion] T ransperitoneal laparoscopic radical nephrectomy for large mass RCC is a safe and feasible operation .It has the risk of open surgery conversion due to abdominal organ injury ,so it should be chosen carefully .