复杂左肾病变肾切除术-肠系膜根部法肾蒂血管处理体会  

Experience of direct access to renal pedicle at the level of Treitz ligament during left complicated nephrectomy

作　　者：董胜国[1] 杨晓坤[1] 于芹超[1] 邵世修[1] 刘勇[1] 孙立江[1] 

机构地区：[1]青岛大学医学院附属医院泌尿外科,266072

出　　处：《现代泌尿生殖肿瘤杂志》2009年第3期134-136,共3页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的介绍复杂左肾病变肾切除术中经肠系膜根部法早期处理左肾肾蒂血管的技巧。方法对51例巨大肾癌(伴或不伴肾静脉癌栓)、肾盂移行细胞癌及脓肾等复杂左肾病变,采用经腹肠系膜根部法早期处理肾蒂,行肾癌、肾盂癌根治术或其他肾切除术。对肠系膜根部、腹主动脉、肾静脉、肾上腺静脉及肠系膜下静脉的解剖关系及手术要点进行了介绍。结果手术均获得满意效果。从入腹腔到显露肾静脉的时间为3～5min,处理肾蒂血管的时间为10～20min。未发生严重并发症,无病例死亡。结论经肠系膜根部法处理肾蒂血管技术是可行的,并具有以下优点:利用肾蒂血管的解剖特点,分离显露肾蒂血管方便、快捷、出血少;不必过多游离、挤压病肾,防止肿瘤或炎症扩散,符合肿瘤根治早期结扎肾蒂血管的原则。本法适合于处理复杂左肾病变,尤其是伴有肾静脉癌栓或脓肾者。Objective To introduce the experience of surgical access to left renal pedicle at the level of Treitz ligament in complicated nephrectomy. Methods A total of 51 left transperitoneal nephrectomies,in complicated cases such as big renal carcinoma（with or without renal vein cancer embolus）, transition cell carcinoma of renal pelvis and pyonephrosis, were performed from September 1997 to December 2008, by direct access to left renal pedical at the level of Treitz ligament. The anat- omy and relationship of Treitz ligament, renal vein, aorta, adrenal vein and inferior mesenteric vein were reviewed and the key point of procedures was described. Results All operations were performed successfully,no operative death,and no severe intraoperative and postoperative complications occurred. The time required to explore the renal vein and to deal with renal pedicle were 3 to 5 minutes,10 to 20 minutes,respectively,after entering the abdominal cavity. Conclusions This access to renal pedicle is technically feasible and operation through it has following advantages：（1）Easy to approach the renal pedicle in the aspects of anatomy and it is safe, quick to deal with renal pedicle with less blood loss. （2）It follows the classic principles of radical nephrectomy allowing to perform the procedure without any manipulation of the tumor. This surgical access is especially suitable for com- plicated left nephrectomy such as radical nephrectomy （with renal vein cancer embolus） and pyonephrosis.

关 键 词：肾切除术 肠系膜根部 肾蒂 

分 类 号：R699[医药卫生—泌尿科学]