后腹腔镜联合下腹部小切口肾盂癌根治术的疗效观察  

The curative effect of retroperitoneal laparoscopy combined with small abdominal incision for treatment of carcinoma of renal pelvis

作　　者：陈江英[1] 许恩赐[1] 江玮[1] 郑松[1] 李梦强[1] 

机构地区：[1]福建医科大学附属协和医院,福建福州350001

出　　处：《腹腔镜外科杂志》2016年第3期223-226,共4页Journal of Laparoscopic Surgery

摘　　要：目的：探讨后腹腔镜联合下腹部小切口行根治性肾输尿管全切除术治疗肾盂癌的可行性及手术疗效。方法：回顾分析2009年11月至2014年7月为29例患者行后腹腔镜联合下腹部小切口技术肾盂癌根治术的临床资料。手术采用腰部三孔法切除患侧肾脏并尽量向膀胱侧游离输尿管,由下腹部5~7 cm小切口取出标本,直视下袖状切除输尿管膀胱壁内段,缝合膀胱切口。结果：29例手术均获成功,无中转开放手术。手术时间100~210 min,平均（150.0±43.5）min;术中出血量50~350 ml,平均（120.0±59.6）ml;术后住院8~12 d,平均（9.5±1.1）d。术后病理均提示尿路上皮癌。术后随访3~48个月,1例发生膀胱肿瘤,1例发生患侧腹膜后复发并双肺转移。结论：对于经验丰富且技术娴熟的外科医生,后腹腔镜联合下腹部小切口肾盂癌根治术是安全、有效的。Objective： To evaluate the feasibility and clinical effect of retroperitoneal laparoscopy combined with small abdominal incision radical nephroureterectomy for carcinoma of renal pelvis. Methods： Between Nov. 2009 and Jul. 2014,29 patients underwent retroperitoneal laparoscopy combined with small abdominal incision radical nephroureterectomy for carcinoma of renal pelvis,the clinical data were retrospectively analyzed. Three Trocars on waist were adopted in the operation for removal the kidney and ureter dissection to the bladder side. The specimen was taken out from a 5-7 cm lower abdominal incision,sleeve resection of ureter in the bladder wall was performed under direct vision,then the bladder incision was sutured. Results： All operations were performed successfully,none was converted to open surgery. The operating time was（ 150. 0 ± 43. 5） min（ range,100-210 min）,the blood loss was（ 120. 0 ± 59. 6） ml（ range,50-350 ml）,the hospital stay after operation was（ 9. 5 ± 1. 1） d（ range,8-12 d）. Pathological examination showed that all cases were urothelial cancer. During the follow-up of 3 to 48 months,1 case suffered from bladder tumor,1 case was found retroperitoneal recurrence and bilateral lung metastasis. Conclusions： It is safe and effective for skilled surgeons with sufficient experience to perform retroperitoneal laparoscopy combined with small abdominal incision radical nephroureterectomy for carcinoma of renal pelvis.

关 键 词：肾盂肿瘤 肾输尿管切除术 腹腔镜检查 腹膜后途径 腹部小切口 

分 类 号：R737.11[医药卫生—肿瘤]