经后腹腔途径腹腔镜下肾癌根治术（附247报告）

目的：报告经后腹腔途经腹腔镜下。肾癌根治术的临床效果。方法：肾癌患者247例术前均行B超、CT、KUB加IVu和（或）逆行造影确诊。右肾癌148例，左肾癌99例。TNM分期：T1N0M0188例，T2N0M059例。均行经腹或后腹腔径路腹腔镜下肾癌根治术。观察手术时间、术中出血量、术后引流量、肠功能恢复时间和术后住院时间。结果：所有手术顺利完成，手术时间80～150min，平均120min。术中出血量100-300ml，平均200ml。术后引流量100-300ml，平均200ml。3～5天拔引流管。术后肠功能恢复时间，经腹途经2～3天，后腹腔径路1～2天。术后住院时间7～9天，平均8天。经腹和后腹腔径路无明显差异。术后病理报告均为透明细胞癌。随访3～36个月，平均15个月；未见肿瘤复发及转移。结论：经腹或后腹腔径路腹腔镜下肾癌根治术，对患者干扰少、创伤小、术后恢复快，明显优于开放手术。经腹途经视野好，后腹腔径路可能对腹腔无干扰。

Retroperitoneal Laparoscopic Radical Nephrectomy (Report of 247 Cases)

Objective：To evaluate the clinical value of retroperitoneal laparoscopic radical nephrectomy. Methods：247 patients were confirmed with renal carcinoma by B ultrasonic examination, IVU plus KUB and （or） retrograde urography. 148 cases were right renal cell carcinoma, 99 cases were left renal cell carcinoma. TNM stage： T 1N 0 M 0188 cases, T 2 N 0 M 059 cases. All cases were underwent transabdominal or retroperitoneal laparoscopic radical nephrectomy. The operation time, blood loss, postoperative drainage volume, intestinal function recovery time and postoperative length of stay were observed. Results： The operating time was from 80 to 150 minutes （ mean 120 minutes）, the blood loss was from 100 to 300 ml （mean 200 ml）, the postoperative drainage volume was from 100 to 300 ml （ mean 200 ml）. Removed drainage tube in 3-5 days. Postoperative intestinal function recovery time was 2-3 days with transabdominal approach, was 1-2 days with retroperitoneal approach. The postoperative hospital stay was from 7 to 9 days （mean 8 days）. There was no significant difference in transabdominal and retroperitoneal approach. All cases were clear cell carcinoma by pathological reports. The postoperative follow-up time was from 3 to 36 months （mean 15 months）. There is no recurrence and metastasis in tumor. Conclusions： The transabdominal or retroperitoneal laparoscopic radical nephrectomy has the merits of mini-invasion, less bleeding and rapid recovery. It is significantly better than open surgery. Transabdominal approach is with good vision, and retroperitoneal approach is with non-intrusive.