单孔后腹腔镜下根治性肾切除寻找肾动脉的新方法  

Novel method for locating renal artery in single port retroperitoneal laparoscopic radical nephrectomy

作　　者：史立新[1] 祝强[1] 蔡伟[1] 董隽[1] 高江平[1] 李宏召[1] 孙圣坤[1] 祖强[1] 张旭[1] 

机构地区：[1]解放军总医院泌尿外科,北京100853

出　　处：《解放军医学院学报》2013年第9期967-969,共3页Academic Journal of Chinese PLA Medical School

摘　　要：摘要：目的验证单孔后腹腔镜下后腹壁肌肉韧带定位肾门寻找肾动脉方法的价值。方法2011年4月-2012年8月我们进行了60例单切口后腹腔镜。肾根治性切除术。男40例，女20例。平均年龄52岁，平均体重指数24．87。所有病例行CT检查提示肿瘤最大径2．3—10．1cm，平均5．16cm。在腋后线12肋下向前做切口5～6cm，放置自制的2个控制环和7号手套构成单孔多通道装置，应用后腹壁肌肉韧带定位法寻找肾动脉的技术进行单孔后腹腔镜下肾根治性切除。结果本组60例均经自制单孔多通道后腹腔镜肾根治性切除手术成功，按照通过腰大肌和膈肌的内侧弓状韧带的指引和参照膈肌脚的走行可以直接定位肾门，分别找到并处理肾动脉和肾静脉，切除肾脏。术中出血20～400ml，手术时间1～3h，平均131min。本组60例均未出现手术并发症。结论应用自制单孔多通道后腹腔镜肾根治性切除手术是安全可行的，后腹壁肌肉韧带定位肾门寻找肾动脉的方法在单孔后腹腔镜相对狭小的操作空间更有实用意义。Objective To verify the value of single port retroperitoneal laparoscopic radical nephrectomy in locating the renal hilus artery. Methods Sixty patients （40 males, 20 females）, at a mean age of 52 years, with a mean BM! of 24.87, who underwent single- site laparoscopic radical nephrectomy in our hospital from April 2011 to August 2012, were included in this study. CT scanning showed that the longest diameter of tumor was 10.1 cm （mean 5.16 cm）. A 5-6 cm incision was made from the posterior axillary line under the lower margin of the 12th rib, into which 2 self-made control loops and a No.7 glove were placed to form the single-port multi- channel device. The renal artery was located using the retroperitoneal abdominal wall muscle ligament positioning method for single port laparoscopic radical nephrectomy. Results The single port retroperitoneal laparoscopic radical nephrectomy was successful for all the 60 patients. The kidneys were removed after the renal hilum, renal artery and vein were located under the guidance of medial arcuate ligament and according to the psoas major muscle. The operation time was 1-3 h （mean 131 minutes）. No surgical complication occurred in all patients. Conclusion It is safe and feasible to use the self-made single-port multi-channel device in retroperitoneal laparoscopic radical nephrectomy. It is more practical to locate the renal artery by positioning the renal hilus through the abdominal wall muscle ligament in the relatively small operating space of single port retroperitoneal laparoscopic radical nephrectomy.

关 键 词：单孔腹腔镜 肾切除 肾动脉 

分 类 号：R692[医药卫生—泌尿科学]