后腹腔镜下解剖性根治性肾切除术168例  

Technique of retroperitoneoscopic anatomical radical nephrectomy

作　　者：张楠[1] 翟振波[1] 金雷[1] 秦卫军[1] 张运涛[1] 杨力军[1] 王禾[1] 袁建林[1] 

机构地区：[1]第四军医大学西京医院泌尿外科,西安710032

出　　处：《中华泌尿外科杂志》2008年第9期588-591,共4页Chinese Journal of Urology

基　　金：总后勤部卫生部科技攻关计划资助项目（06MA228）;陕西省科技攻关计划资助项目（2005K12-G4）

摘　　要：目的介绍后腹腔镜下解剖性根治性肾切除术的手术方法及临床效果。方法对168例肾癌患者实施后腹腔镜下解剖性根治性肾切除术。肿瘤位于左肾87例，右肾81例。肿瘤直径2．0～6．9cm，平均4．7cm。T1aN0M0 92例，T1bN0M0 76例。常规制备后腹腔间隙。按顺序分别进入4个相对无血管解剖层而进行分离。第一分离层面位于腰肌前间隙，此层面可以在手术初期快速找到肾蒂；第二分离层面位于Gerota筋膜前叶与融合筋膜之间；第三分离层面位于肾上腺与肾上极之间或膈肌与肾上腺间隙；第四分离层面位于Gerota筋膜的锥尖部。结果168例手术均成功完成，平均手术时间（138±46）min，平均术中出血量（90±30）ml。恢复饮食和下床活动时间分别为1．3d和1．2d。术后平均住院日5．8d。14例发生腹膜破口，未影响手术进行。18例术后有不同程度肩痛，2d后自行消失。123例随访6～18个月，平均8个月，均无瘤生存。结论后腹腔镜下解剖性根治性肾切除术具有解剖层次清楚、术中出血少、术野清晰、疗效确切、并发症少、恢复快等优点，为需要根治性肾切除术的患者提供了更好的选择。Objective To introduce the technique and evaluate the clinical effect of retroperito neoscople anatomical radical nephrectomy. Methods One hundred and sixty eight patients under went retroperitoneoseopic anatomical radical nephrectomies. The average tumor size was 4.7 cm （ran ging from 2.0-6.9 cm） in diameter. There were 87 tumors in the left kidney and 81 tumors in right kidney. Ninety two cases were in clinical stage T1aN0M0 and 76 in T1bN0M0. Retroperitoneal space was created routinely at lateral deeubitus position. Four relatively bloodless planes were orderly entered for exposure and separation of the kidney outside Gerota＇s fascia. The first dissection plane was between the psoas and posterior Gerota＇s fascia. The renal pediele was found in this plane. The following dissections proceeded in the plane between posterior Gerota＇s fascia and fusion fascia. The third dissection plane was between adrenal gland and the upper pole of kidney or between the adrenal gland and diaphragma. The fourth dissection plane was in the bottom of Gerota＇s fascia. Results All operations were successfully completed. The mean operative time was 138±46 rain and estimated blood loss was 90±30 ml. The average day of resuming oral intake was 1.3 d and time of ambulation was 1.2 d. The mean postoperative hospital stay was 5.8 d. Peritoneum injuries happened in 14 patients. Omalgla occurred in 18 patients and disappeared 2 d after operation. One hundred and twenty-three patients were followed up, they all survived during the average follow-up of 8 months （ranging from 6 18 months）., Conclusions Retroperitoneoscopic anatomical radical nephrectomy is a safe and effective procedure. It can decrease operation time, blood loss and complication rate remarkably. It is a good option for patients needing radical nephrectomy.

关 键 词：根治性肾切除术 后腹腔镜 手术治疗 治疗方法 

分 类 号：R699[医药卫生—泌尿科学]