后腹腔镜肾癌根治术治疗41例肾癌的临床观察

目的：探讨后腹腔镜肾癌根治术的手术方法及其临床效果。方法：本组患者均采用气管插管麻醉。在腹腔镜下行患肾切除术。结果：手术时间100—160分钟，平均120分钟；术中出血量40—300ml，平均80ml。肠道恢复时间为术后1-3天，平均1．5天。术后2-4天开始进食。手术后7—12天痊愈出院。术后随访1—19个月，平均随访8个月，一般状况均良好，无肿瘸复发及转移。结论：后腹腔镜肾癌根治术具有创伤小、解剖清晰、术中出血少、术后恢复快等优点，是一种安全、有效的治疗方法。

Clinical Observation of Posterior Laparoscopic Radical Nephrectomy:A Report of 41 Cases

Objective: To investigate the surgical technique and clinical effectiveness of posterior laparoscopic radical nephrectomy. Methods: A 10-mm Trocar (a laparoscopic plunger) was put in intersection between the midaxillary line and the site 2cm away from superior border of the iliac crest and aeroperitonium and retroperitoneal lacouna were set up by infusion of CO2 gas. Under monitoring of TV, the site 2cm below the costal margin 12 of the postaxillary line and below the costal margin of preaxillary line was chosen for respective puncturation of a 12-mm and a 5-mm Trocar in posterior abdominal cavity as the access of operative procedure. The resection of the sick kidney was performed by laparoscope. The incision line of the 12-mm and 5-mm Trocar was cut open one by one and resected samples were taken out. Results: The operation time was 100 to 160 min (median 120 min) and the intra-operative blood loss was 40 to 300m1 (mean: 80 m1). The recovery time of intestinal tract was 1 to 3 days after operation, with an average of 1.5 days. Foodintake started 2 to 4 days after operation and the patients discharged from hospital 7 to 12 days after operation. Report of the histopathological examination revealed that there were 34 cases with suprarenal epithelioma, 2 chromophobe carcinoma, 1 eosinophil carcinoma, 1 malignant striped muscle tumor, 3 cystadenocarcinoma. Three cases changed into open surgery owing to the intra-operative complication. The postoperative follow up was conducted for 1 to 19 months (mean: 8 months), without recurrence and metastasis. Conclusion: The posterior laparoscopic radical nephrectomy has the merits of minor wound, less bleeding and rapid recovery and is the safe and effective method of treatment for patients with renal cancer.