生殖静脉标志法肾蒂定位在腹腔入路腹腔镜根治性肾切除术中的应用  

Application of vena genitalis marking for renal pedicle location in transperitoneal laparoscopic radical nephrectomy

作　　者：任选义 于栓宝 陶金[2] 刘建华 李腾飞 朱照伟[2] 张雪培[2] REN Xuanyi;YU Shuanbao;TAO Jin;LIU Jianhua;LI Tengfei;ZHU Zhaowei;ZHANG Xuepei(Department of Urology,Central Hospital of Kaifeng,Kaifeng 475000;The first Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]开封市中心医院,河南开封475000 [2]郑州大学第一附属医院,河南郑州450052

出　　处：《现代泌尿外科杂志》2021年第2期120-123,共4页Journal of Modern Urology

摘　　要：目的探讨生殖静脉标志法肾蒂血管定位在腹腔入路腹腔镜根治性肾切除术(LRN)中应用的可行性和手术效果。方法回顾性分析2015年1月至2019年12月郑州大学第一附属医院和开封市中心医院实施腹腔入路LRN的295例肾肿瘤患者资料,术中以生殖静脉为标志定位并处理肾蒂大血管,根治性切除肾脏和肿瘤,记录技术运用、生殖静脉解剖特点、手术时间、出血量和围术期并发症等,分析其临床数据并进行统计学处理。结果295例腹腔入路LRN成功应用“生殖静脉标志法”定位肾蒂血管,142例右肾手术中的120例生殖静脉注入下腔静脉、22例注入右肾静脉;153例左肾手术中的152例生殖静脉注入左肾静脉、1例注入下腔静脉。中位手术时间55 min。中位出血量50 mL,术中血管损伤6例。295例术后病理报告肾细胞癌268例,其他病理类型27例。术后中位住院时间7 d,胃肠功能恢复时间1.5 d,无迟发性大出血发生,切口感染2例,未见Clavien 4级以上并发症。随访4~51个月,失访36例,1例切口疝、7例肾功能不全、2例局部肿瘤复发、13例肿瘤转移、17例死亡。结论腹腔入路LRN术中,以恒定存在的生殖静脉为解剖学标记,能够准确定位肾蒂大血管,手术安全可行。Objective To explore the feasibility and surgical effects of vena genitalis marking for the location of renal pedicle vessels in transperitoneal laparoscopic radical nephrectomy(LRN)for the treatment of renal tumors.Methods The clinical data of 295 cases of renal tumors who received LRN during Jan.2015 and Dec.2019 were retrospectively analyzed.During the operation,the genital veins were used as a marker to locate the vessels of the renal pedicle,and the kidney and tumorwere resected radically.The data of technological application,anatomical characteristics of genital veins,operation time,bleeding volume and perioperative complications were recorded and analyzed.Results In all 295 cases,the renal pedicles were located successfully.In 142 right renal surgeries,the genital veins entered the inferior vena cava in 120 cases and entered the right renal vein in 22 cases.In 153 left renal surgeries,the genital veins entered the left renal vein in 152 cases and entered the inferior vena cava in 1 case.The median operation time was 55 mins,and median blood loss was 55 mL.Vascular injury occurred in 6 cases.Postoperative pathological results showed 268 cases of renal cell carcinoma and 27 cases of other pathological types.The median postoperative hospital stay was 7 days and the gastrointestinal recovery time was 1.5 days.No delayed massive hemorrhage was observed.Wound infection occurred in 2 cases.No complications above Clavien grade 4 were observed.During the follow-up of 4 to 51 months,36 cases were lost,1 case developed incisional hernia,7 cases had renal insufficiency,2 cases had local tumor recurrence,13 cases had tumor metastasis and 17 cases died.Conclusion In transperitoneal LRN,the genital veins as a constant anatomical marker can accurately locate renal pedicle vessels and the surgery is safe and feasible.

关 键 词：腹腔镜手术 腹腔入路 根治性肾切除 生殖静脉标志法 手术疗效 并发症 

分 类 号：R692.4[医药卫生—泌尿科学]