经腹腔巨大肾癌根治术的临床分析

目的 总结经腹部入路根治性肾切除术治疗巨大肾癌(肿瘤直径≥12 cm)的经验.方法 2002年5月至2009年5月收治巨大肾癌患者45例.选择肋下斜切口经腹腔人路,利用肝脏拉钩显露术野;先结扎肾动脉,阻断肾脏血供之后游离非肿瘤侧组织;分离肿瘤时,将微创技术(如钛夹、Hem-o-lock)应用术中;遇肝下腔静脉癌栓,心耳钳阻断癌栓周围腔静脉,将癌栓取出.回顾性总结手术时间、术中并发症、估计术中出血量、术后住院时间、术后病理等.结果 肿瘤直径12.2～28.3 cm,平均14.5 cm.手术时间(150±58)min,术中估计出血量(350±180)ml,输血3例(6.7%),住院时间(12±6)d.本组术中无十二指肠、肝脏、结肠及大血管损伤,术后无腹腔感染及术后肠梗阻.因肿瘤侵犯腹膜累及脾被膜粘连紧密及暴露肾上极致脾损伤各1例,切除脾脏2例(4.4%);术后病理分期,T_2N_(0～1)M_(0～1)期13例,T_3N_(0～1)M_(0～1)期23例,T_4N_(0～1)M_(0～1)期9例.随访3～63个月,肾床肿瘤复发3例(6.7%).结论 经腹部入路行根治性肾切除术治疗巨大肾癌是安全、有效的术式,术中应用肝脏拉钩手术视野显露良好,应用钛夹、Hem-o-lock阻断肿瘤周围血管,可减少术中出血.术中应注意保护脾脏.

Experiences of open transperitoneal radical nephrectomy for large renal masses

Objective To evaluate the effect of technical improvements of transperitoneal radical nephrectomy on the patients with large renal cell carcinoma.Methods From May 2002 until May 2009,45patients with large(＞12 cm)renal cell carcinoma underwent transperitonel radical nephrectomy.A subcostal incision was selected to expose the extraperitoneal area.The modified operative methods included exposing the operative field via a liver retractor and initially ligating renal artery to block the blood supply of kidney and tumor.The method of tumor-free tissue dissociation was applied.Hem-o-lock was employed for clipping so as to avoid hemorrhage.This modified technique was evaluated in respects of operating time,estimated blood loss,intra-operative complications,postoperative complications,length of hospital stay and pathological diagnoses.Results The tumor diameter was from 12.2 cm to 28.3 cm with a mean of 14.5 cm.The mean operative time was(150±58)min and the average estimated blood loss(350±180)mLThree cases received blood transfusion.The average length of hospital stay was (12±6)days.Three cases developed complications,including spleen injury in 2 and pancreatic injury in 1.The treatment modalities were splenectomy and resection of pancreatic tail respectively.The pathological diagnoses were all of renal cell carcinoma.The pathological stage included T_2N_(0～1)M_(0～1)(n=13),T_3N_(0～1)M_(0～1)(n=23),T_4N_(0～1)M_(0～1)(n=9).After a follow-up period of 3-63 months,3 cases of tumor recurrence were found in primary renal clutch.Conclusion Improved radical nephrectomy is feasible for large renal cell carcinoma.And it cam reduce tlle volume of blood loss and decrease the occurrence of complications.