非同步处理肾蒂血管技术在后腹腔镜复杂性肾癌肾盂癌根治术中的应用探讨  

The non-synchronous treatment of renal pedicle in retroperitoneal laparoscopic radical resection of complex renal carcinoma and renal pelvic tumor

作　　者：陶光晶 武国军 张选举[1] 余义[1] 江铎[1] 熊丙建[1] Tao Guangjing;Wu Guojun;Zhang Xuanju;Yu Yi;Jiang Duo;Xiong Bingjian(Department of Urology,Ankang City Central Hospital,Shaanxi Ankang 725000,China;Department of Urology,Xijing Hospital,Air Force Medical University,Shaanxi Xi'an 710032,China)

机构地区：[1]安康市中心医院泌尿外科,陕西安康725000 [2]空军军医大学西京医院泌尿外科,陕西西安710032

出　　处：《现代肿瘤医学》2020年第7期1157-1161,共5页Journal of Modern Oncology

基　　金：国家自然科学基金资助项目(编号:81272812)。

摘　　要：目的:探讨经后腹腔入路行腹腔镜复杂性肾癌肾盂癌根治术肾蒂血管非同步处理技巧。方法:2010年1月至2018年4月就诊于我科的109例肾癌、肾盂癌患者接受腹膜后入路腹腔镜根治性肾切除术。根据肾蒂血管处理方式的差异分别纳入非同步组和同步组。非同步组患者61例,其中肾癌43例,肾盂癌18例;同步组患者48例,其中肾癌33例,肾盂癌15例;均采用3套管技术,从腹膜后入路,显露肾蒂,非同步组优先处理肾动脉,游离肾脏,最后结扎肾静脉。同步组先游离出肾动脉及肾静脉予以结扎,最后游离肾脏。分别对两组患者的手术时间、术中失血量进行统计分析。结果:非同步组1例男性患者因左肾肉瘤浸润腰大肌、腹膜及结肠,粘连严重转为开放手术,予以排除,两组其余患者均顺利完成手术。非同步组与同步组手术时间分别为:肾癌(94.3±28.1)min vs (113.3±40.3)min,肾盂癌(135.2±43.3)min vs (168.2±37.2)min;术中出血量分别为:肾癌(68.4±56.8)ml vs (100.7±93.1)ml,肾盂癌(105.4±37.3)ml vs (131.3±36.3)ml。比较两组患者病种间手术时间及术中出血量均有统计学差异(P <0. 05)。结论:肾蒂血管的处理是复杂性肾癌、肾盂癌经后腹腔镜根治切除的关键,术中灵活的肾血管处理应对尤为重要,非同步肾蒂血管处理技巧有助于减少术中出血量,缩短手术时间,增加手术安全性。Objective:To explore the operative skills of renal pedicle in retroperitoneal laparoscopic radical resection of complex renal tumors and renal pelvic tumors.Methods:From January 2010 to April 2018,109 cases of laparoscopic radical resection of renal tumors and renal pelvic tumors through retroperitoneal approach were performed by the same operator.Of all cases,61 received non-synchronous treatment,including 43 cases of renal carcinoma and 18 cases of renal pelvic tumor.The other 48 received synchronous treatment,including 33 cases of renal carcinoma and 15 cases of renal pelvic tumor.For all cases,the 3-trocar method was applied to show the renal pedicle from the retroperitoneal approach.In non-synchronous treatment group,the renal artery was preferentially treated,then the kidney was free,finally the renal vein was ligated.Synchronous treatment group dealt with the renal arteries and veins sequentially before dissociated the kidney.The operation time and intraoperative blood loss between the two groups were observed and compared.Results:One case in the non-synchronous treatment group underwent open surgery due to severe adhesion,the rest of the cases in the two groups were completed successfully.For the renal carcinomas and renal pelvic tumors,the operation time of non-synchronous treatment group and synchronous treatment group were respectively(94.3±28.1)min vs(113.3±40.3)min,(135.2±43.3)min vs(168.2±37.2)min.The intraoperative blood loss of two groups were respectively(68.4±56.8)ml vs(100.7±93.1)ml,(105.4±37.3)ml vs(131.3±36.3)ml.There were significant differences between the two groups(P<0.05).Conclusion:The key of the retroperitoneal laparoscopic radical resection of complex renal tumors and renal pelvic tumors is the treatment of the renal pedicle vessels.The flexible selection of operative skills of renal pedicle is important.Non-synchronous treatment will conduce to reduce the intraoperative bleeding,shorten the operation time and improve surgical safety.

关 键 词：非同步肾蒂血管处理 后腹腔镜肾切除术 上尿路肿瘤 

分 类 号：R737.12[医药卫生—肿瘤]