Hem-o-lok在后腹腔镜肾切除术中的应用  

Application of the Hem-o-lok in Retroperitoneal Laparoscopic Nephrectomy

作　　者：赵磊[1] 马潞林[1] 侯小飞[1] 张树栋[1] 张荣新[1] 

机构地区：[1]北京大学第三医院泌尿外科,北京100083

出　　处：《中国微创外科杂志》2007年第8期743-744,共2页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨后腹腔镜下肾切除术中带锁塑料夹(Hem-o-lok)的应用效果。方法2003年11月～2006年11月行后腹腔镜下肾切除术178例。取腰部3个穿刺点入路,肾动脉和静脉分别用Hem-o-lok夹闭后切断,输尿管在近髂血管处切断。对于活体取肾,立即取出肾脏用4℃肾脏保存液灌注肾脏。结果178例手术均成功,无中转开放手术,无Hem-o-lok滑脱。手术时间平均100min(60～200min),术中出血量平均95ml(20～200ml)。并发症2例:肾静脉损伤1例,胰尾损伤1例。术后住院平均5d(4～8d)。病理报告:65例肾透明细胞癌,肾囊腺癌3例,平滑肌肉瘤1例,肾淋巴瘤1例,肾嗜酸细胞瘤2例,肾错构瘤2例;输尿管移行细胞癌12例,输尿管鳞癌2例;肾盂移行细胞癌31例,肾盂黄色肉芽肿1例;肾结核4例,副肾1例,肾结石4例,肾积水4例,肾脓肿1例。136例随访1～36个月,平均25个月,64例随访<1年,53例随访1～2年,19例随访2～3年,未发现肾窝及切口转移,未发现远处转移。结论后腹腔镜下肾切除术中使用Hem-o-lok处理肾脏血管安全可靠,疗效良好,对于活体取肾保证供肾血管长度有优势。Objective To evaluate the satety and effectiveness of the Hem-o-Ink in retroperitoneal laparoscopic nephrectomy. Methods A total of 178 patients underwent retroperitoneal laparoscopic nephrectomy from November 2003 to November 2006. The operation was performed through 3 lumbar ports. The renal artery and veins were blocked with the Hem-o-Ink and then severed. The ureter was cut at the site near the iliac blood vessel. For living donor nephrectomy, the kidney was taken out and infused with 4℃ kidney preserving fluid immediately. Results The operation was successfully completed in all the 178 cases and there was no conversion to open surgery. No Hem-o-Ink ligating clips became dislodged. The mean operation time was 100 min （60 -200 min） , and the mean blood loss was 95 m[ （20 - 200 ml）. Complications included renal vein injury in [ patient and pancreatic tail injury in l patient. The mean length of postoperative hospital stay was 5 days （4 -8 days）. Pathological results showed renal clear cell carcinoma in 65 patients, renal cystadenocarcinoma in 3 patients, renal leiomyosarcoma in 1 patient, renal lymphoma in 1 patient, renal oncocytoma in 2 patients, renal hamartoma in 2 patients, nreteral transitional cell carcinoma in 12 patients, ureteral squamous cell carcinoma in 2 patients, renal pelvis transitional cell carcinoma in 31 patients, renal pelvis xanthogranuloma in l patient, renal tuberculosis in 4 patients, accessory kidney in 1 patient, renal calculus in 4 patients, nephrohydrosis in 4 patients, and renal abscess in 1 patient. A total of 136 patients were followed for 1 -36 months （mean, 25 months） , involving 64 patients followed for 〈 1 year, 53 patients for 1 -2 years, and 19 patients for 2 -3 years. No metastasis （kidney bed, port site, or distant organs） was found. Conclusions The Hem-o-lok can be used safely and reliably in retroperitoneal laparoscopic nephrectomy, especially in living donor nephrectomy requiring long donor blood vessels.

关 键 词：腹腔镜 肾切除术 Hem-o-lok 

分 类 号：R699.2[医药卫生—泌尿科学]