后腹腔镜下根治性肾切除术技术改进与并发症防治  

Retroperitoneal laparoscopic radical nephrectomy： technical improvements and complication prevention

作　　者：张海梁[1] 叶定伟[1] 姚旭东[1] 张世林[1] 戴波[1] 沈益君[1] 朱耀[1] 朱一平[1] 施国海[1] 马春光[1] 

机构地区：[1]复旦大学附属肿瘤医院泌尿外科,上海200032

出　　处：《中华泌尿外科杂志》2009年第5期302-305,共4页Chinese Journal of Urology

摘　　要：目的探讨后腹腔镜下根治性肾切除术中技术改进对降低手术难度和风险以及减少术中及术后并发症的作用。方法早期肾癌患者61例，均行后腹腔镜下根治性肾切除术治疗。术前根据增强CT检查判断肿瘤血管分布情况。术中采用30°自动对焦电子镜，自制气囊扩张器建立后腹膜间隙，全程使用超声刀分离，充分剥除腹膜外脂肪，分离时尽量保护腹膜，先游离肾脏周围，最后处理肾蒂，充分游离肾动、静脉，Hem—o—lok夹分次处理肾动、静脉。结果61例手术时间50～135min，平均70min，术中出血量20～170ml，平均6jm1。术后引流量20～210ml，平均85m1。术后住院3～15d，平均5d。术中发生下腔静脉损伤1例，以钛夹和Hem—o—lok夹夹闭破口；十二指肠穿孔1例，行一期开放修补。结论后腹腔镜下根治性肾切除术中使用30°自动对焦电子镜、气囊扩张和超声刀，手术视野更清晰，暴露更全面，直视下操作能更有效地降低手术难度，减少术中和术后并发症。Objective To introduce the technical improvements in retroperitoneal laparoscopic radical nephrectomy and discuss their roles in decreasing the perioperative complication. Methods Sixty-one patients with localized renal cell carcinoma were treated with retroperitoneal laparoscopic radical nephreetomy from December 2006 to March 2008. Pre-operative CT scan was performed to evaluate the renal vessel status. Thirty degree laparoscope was used together with self-made balloon dilator to establish the retroperitoneal space. Harmonic scalpel was used in dissection and removal of the extra-peritoneal fat. Cautions were taken during the separation of peritoneum. The renal artery and vein were separated and ligated with Hem-o-lok clips. Complications such as vessel split and intestinal injury were recorded. Operation time, estimated blood loss, drainage volume, and length of hospital stay were analyzed as well. Results The operation time was 50--135 min, estimated blood loss during operation was 20--170 ml, post-operative drainage volume was 20--210 ml, mean post-operative length of hospital stay was 5 d. Two complications occurred during the operation： one was a vena cava injury, and another was a minor duodenum wall perforation. Conclusions Retroperitoneal lapa- roseopic radical nephrectomy is an effective and safe surgical option for localized renal cell carcinoma. Improvements in this surgical technique bring more safety and convenience and could decrease perio- perative complications relatively.

关 键 词：肾肿瘤 肾切除术 腹腔镜 并发症 

分 类 号：R686[医药卫生—骨科学]