基于生殖静脉导引的精准膜解剖经腹腔入路腹腔镜根治性肾切除术35例经验总结  

Experienceof transperitoneal laparoscopic radical nephrectomy based on the membrane anatomy guided by the genital vein in 35 cases

作　　者：谭伍兵 陈晓峰[2] 张威[2] 邓旺龙[2] 孙建明[2] 吴志坚[2] 邹义华[2] TAN Wubing;CHEN Xiaofeng;ZHANG Wei;DENG Wanglong;SUN Jianming;WU Zhijian;ZOU Yihua(Xiangyang Central Hospital,Affiliated Hospital of Hubei University of Arts and Science,Xiangyang 441000,China;不详)

机构地区：[1]湖北文理学院附属医院襄阳市中心医院,襄阳441000 [2]郴州市第一人民医院湘南学院第一附属医院泌尿外科

出　　处：《现代泌尿生殖肿瘤杂志》2022年第4期205-209,共5页Journal of Contemporary Urologic and Reproductive Oncology

基　　金：湘南学院2020年度校级科研项目(2020XJ84)。

摘　　要：目的探讨基于生殖静脉导引的膜解剖经腹腔入路腹腔镜根治性肾切除术治疗肾癌的安全性与疗效。方法选取2018年1月至2021年6月郴州市第一人民医院泌尿外科收治的35例肾癌患者,年龄43~81岁,平均(57.9±9.6)岁;肿瘤直径3.6~10.6 cm,平均(6.5±1.8)cm;左肾肿瘤19例,右肾肿瘤16例;术前临床分期cT_(1a)N_(0)M_(0)1例,cT_(1b)N_(0)M_(0)13例,cT_(2a)N_(0)M_(0)10例,cT_(2b)N_(0)M_(0)9例,cT_(3a)N_(0)M_(0)1例,cT_(3a)N_(0)M_(0)11例。手术均由同一高年资医师完成,按照生殖静脉导引肾静脉的技术路线,运用膜解剖技术分离肾脏周围无血管平面,实施经腹腔入路腹腔镜根治性肾切除术。结果35例患者均顺利完成手术,除1例转移性肾癌行减瘤性根治性肾切除外,其余34例均保留同侧肾上腺。手术时间120~200 min,平均(150.5±20.3)min;术中出血量30~300 ml,平均(45.5±9.2)ml,无术中、术后输血病例;术后病理类型:肾透明细胞癌22例,乳头状肾细胞癌5例,嫌色性肾细胞癌4例,黏液样小管状和梭形细胞癌2例,未分类的肾细胞癌2例;病理分期:pT_(1a)N_(0)M_(0)1例,pT_(1b)N_(0)M_(0)12例,pT_(2a)N_(0)M_(0)10例,pT_(2b)N_(0)M_(0)8例,pT_(3a)N_(0)M_(0)3例,pT_(3a)N_(0)M_(1)1例;术后肠鸣音恢复时间1.0~2.5 d,平均(1.5±0.4)d;术中、术后均无严重并发症发生;术后住院时间5.0~10.0 d,平均(7.2±1.5)d;术后疼痛视觉模拟评分1~7分,平均(3.1±1.1)分;术后1例失访,1例转移性肾癌行减瘤性肾切除术后靶向药物治疗无效死亡,其余33例均获随访,随访时间6~45个月,中位随访时间21个月,暂无局部复发与远处转移发生。结论按照生殖静脉导引肾静脉的手术思路,运用膜解剖技术实施经腹腔入路腹腔镜根治性肾切除术所见解剖结构清晰、组织层次分明,可安全根治肿瘤,疗效满意,值得在临床上推广运用。Objective To investigate the safety and efficacy of transperitoneal laparoscopic radical nephrectomy for renal carcinoma based on membrane anatomy guided by genital vein.Methods The clinical data of 35 patients with renal carcinoma who underwent transperitoneal laparoscopic radical nephrectomy from January 2018 to June 2021 were retrospectively analyzed.The average age of the patients was(57.9±9.6)years old(range,43-81 years).Among them,there were 19 cases of left renal cell carcinoma and 16 cases of right renal cell carcinoma.The diameter of the tumor was 3.6 to 10.6 cm,with an average of(6.5±1.8)cm.The preoperative clinical stages were 1 case of cT_(1a)N_(0)M_(0),13 cases of cT_(1b)N_(0)M_(0),10 cases of cT_(2a)N_(0)M_(0),9 cases of cT_(2b)N_(0)M_(0),1 case of cT_(3a)N_(0)M_(0)and 1 case of cT_(3a)N_(0)M_(1).All the operations were performed by the same senior surgeon.According to the technical route of genital vein guiding renal vein,membrane dissection technology was used to separate the avascular plane around the kidney.Transperitoneal laparoscopic radical nephrectomy was performed for all the patients.Results All the 35 patients were operated successfully.The time of radical nephrectomy was 120-200 minutes,with an average of(150.5±20.3)minutes.Intraoperative blood loss was 30-300 ml,with an average of(45.5±9.2)ml.The postoperative pathological stages were 1 case of pT_(1a)N_(0)M_(0),12 cases of pT_(1b)N_(0)M_(0),10 cases of pT_(2a)N_(0)M_(0),8 cases of pT_(2b)N_(0)M_(0),3 cases of pT_(3a)N_(0)M_(0)and 1 case of pT_(3a)N_(0)M_(1).The recovery time of postoperative bowel sound was 1.0 to 2.5 days,with an average of(1.5±0.4)days.There were no serious complications during and after the operation.The postoperative hospital stay was 5 to 10 days,with an average of(7.2±1.5)days.The postoperative visual analogue scale(VAS)was 1-7 points,with an average of(3.1±1.1)points.One case lost follow-up after operation,one case of metastatic renal cancer died of ineffective targeted drug treatment after tumor reductio

关 键 词：膜解剖 肾癌 根治性肾切除术 腹腔镜 经腹腔入路 

分 类 号：R737.11[医药卫生—肿瘤]