腹膜后腹腔镜肾脏切除术的临床研究(附54例报告)

目的:探讨腹膜后腹腔镜肾脏切除术的手术方法及临床效果。方法:2003年6月至2008年6月我院行腹膜后腹腔镜肾癌根治术14例,肾盂癌根治术2例,单纯肾切除术38例。男16例,女38例,21～74岁,平均(48.6±10.3)岁。肾肿瘤直径2.0～6.0cm,平均(3.8±1.2)cm,术前临床分期T1aN0M09例、T1bN0M05例。单纯肾切除患者中肾结核12例,巨大肾积水22例,肾动脉狭窄4例,均经肾图检查证实患肾无功能。记录手术时间、术中出血量和住院时间。结果:除1例脓肾因周围粘连严重,中转开放外,余53例均顺利完成腹腔镜手术。手术时间65～185min,平均(93.5±28.0)min,出血50～1200ml,平均(156±64)ml,平均住院(8.2±4.0)d。随访3～60个月,患者均生存。结论:腹膜后腹腔镜肾脏切除术患者创伤轻,出血少,术后康复快,临床疗效良好。

Clinical study on retroperitoneal laparoscopic nephrectomy:a report of 54 cases

Objective:To investigate the surgical technique and clinical effect of retroperitoneal laparoscopic nephrectomy.Methods:From June 2003 to June 2008,a total of 54 patients have undergone retroperitoneal laparoscopic nephrectomies in our department,with 14 cases undergoing radical nephrectomies,2 cases undergoing radical nephroureterectomies and 38 cases undergoing simple nephrectomies.The tumors were averagely(3.8±1.2)cm(range 2.0 to 6.0cm)in diameter,with 9 cases at T1aN0M0 stage,5 cases at T1bN0M0 stage.Among the 38 simple nephrectomy cases,12 cases were kidney tuberculosis,22 cases were hydronephrosis,and 4 cases were renal arterial stenosis.All the kidneys were confirmed to have no function by radiological renal pictures.The operating time,intraoperative blood loss volume,and the time of hospitalization were recorded.Results:Fifty-three cases were completed successfully.Only one case was converted to open operation because of severe conglutination.The operating time was 65-185min,mean(93.5±28.0)min,and the blood loss was 50-1 200ml,mean(156±64)ml.The average time of hospitalization was(8.2±4.0)days.All patients survived during a follow-up of 3-60 months.Conclusions:Retroperitoneal laparoscopic nephrectomy,with minimal invasion,less blood loss and quicker postoperative recovery,is a practical surgical procedure.