后腹膜腹腔镜肾癌根治性手术安全性的临床研究

目的:探讨后腹膜腹腔镜肾癌根治术临床应用的安全性。方法:行后腹腔镜肾癌根治术27例,经腹腹腔镜行肾癌根治术24例,比较两种方法肠管及大血管的损伤、手术时间、出血量、住院时间、CO2对机体的影响(血气分析:PaCO2、pH)、肠道恢复时间、肠粘连、术后肩痛、切口种植转移的差别。结果:后腹腔镜手术时间为(180±30)m in,出血80~300m l,平均120m l,均未输血,平均住院7d;切口种植转移1例,术后肩痛1例,肠道恢复时间(24±4)h,血气分析pH(7.35±0.11)、PaCO2(42.45±6.15)mm Hg;经腹腹腔镜3例穿刺损伤肠管、2例损伤腹部血管,手术时间(200±40)m in,出血100~300m l,平均200m l,均未输血,血气分析pH(7.40±0.10)、PaCO2(43.45±6.45)mm Hg;平均住院10d,术后肩痛8例,肠道恢复时间(38±6)h,2例发生肠梗阻。结论:后腹腔镜肾癌根治术同经腹腹腔镜肾癌根治术相比,出血少,康复快,血管及肠管的损伤、肠道功能恢复、术后肩痛均有显著性差异(P<0.05);血气分析,切口种植转移无显著性差异(P>0.05)。手术效果相当。

Clinical study the safety of the retroperitoneal laparoscopic radical nephrectomy

Objective:To summary the experience of retroperitoneal laparoscopic radical nephrectomy and transperitoneal laparoscopic radical nephrectomy.Methods:Twenty-seven retroperitoneal laparoscopic radical nephrectomy and twenty-five transperitoneal laparoscopic radical nephrectomy were performed,operation time,blood loss,risks related to trocar insertion,CO_2 absorption,postoperative ileus,shoulder pain,length of stay and effect of operation of them were comparatively studied.Results:All cases were performed successfully.There was no case converting to open surgery.In retroperitoneal laparoscopic radical nephrectomy the operative time was(180±30)min,the average blood loss was 120ml and the time of recovery of bowel function was(24±4)h.In transperitoneal laparoscopic radical nephrectomy the operative time was(200±40)min.The average blood loss was 200ml and the time of recovery of the bowel function was(38±6)h.Conclusions:Retroperitoneal laparoscopic radical nephrectomy was superior to transperitoneal laparoscopic radical nephrectomy,It has the merits of less blood loss,less shouder and neck pain and faster recovery of the bowel function.