基于生殖静脉为导引的“一线一面”精准解剖技术在经腹腔入路腹腔镜根治性肾切除术中的应用  

Application of"one line,one plane"precise dissection technique guided by the genital vein in transperitoneal laparoscopic radical nephrectomy

作　　者：王磊 力威 李乾 张先云 王苏贵 Wang Lei;Li Wei;Li Qian;Zhang Xianyun;Wang Sugui(Department of Urology,Affiliated Huai′an Hospital of Xuzhou Medical University,Huai′an 223002,China)

机构地区：[1]徐州医科大学附属淮安医院泌尿外科,淮安223002

出　　处：《中华转移性肿瘤杂志》2024年第6期588-592,共5页Chinese Journal of Metastatic Cancer

基　　金：江苏省第十六批“六大人才高峰”项目资助(2019-WSW-218)。

摘　　要：目的探讨基于生殖静脉为导引的“一线一面”精准解剖技术在经腹腔入路腹腔镜根治性肾切除术(LRN)中的临床应用效果。方法回顾性分析2018年2月至2022年12月于徐州医科大学附属淮安医院行经腹腔入路LRN的62例肾肿瘤患者临床资料,观察手术时间、术中出血量、血管损伤和术后并发症等相关手术指标。结果62例患者中男40例、女22例,年龄45~78岁,平均(51±8.4)岁;左肾肿瘤38例,右肾肿瘤24例,肿瘤直径3.8~10.2 cm,平均(6.1±1.7)cm;术中基于生殖静脉走行为导引的主轴线(一线)和以肾下极腰大肌平面(一面)精准解剖肾蒂血管。62例患者均顺利完成手术,无中转开放。平均手术时间(54.7±11.4)min;术中平均出血量(50.5±12.1)ml,无输血患者;术中血管损伤2例,行腹腔镜下相应处理;术后出现淋巴漏2例,切口脂肪液化1例,均保守治疗成功,未出现Clavien-Dindo≥3级并发症。结论基于生殖静脉为导引的“一线一面”精准解剖技术实施经腹腔入路LRN,解剖层面清晰,肾蒂血管暴露满意,术中及术后并发症少,手术安全可行。Objective To explore the clinical application of"one line,one plane"precise dissection technique guided by the genital vein in transperitoneal laparoscopic radical nephrectomy(LRN).Methods The clinical data of 62 cases of kidney tumors who underwent transperitoneal LRN from February 2018 to December 2022 in the Affiliated Huai′an Hospital of Xuzhou Medical University were analyzed retrospectively.Relevant surgical indicators such as duration of surgery,intraoperative blood loss,vascular damage,and postoperative complications were observed.Results There were 62 patients,including 40 males and 22 females aged(51±8.4)years old on average(range:45~78 years).38 tumors were located in the left kidney,and 24 in the right kidney.The diameter of kidney tumors was 3.8~10.2 cm,with an average of(6.1±1.7)cm.The vessels of the renal pedicle were dissected precisely with the course of the genital vein as the main axis(one line)and the psoas major muscle at the inferior pole of kidney as the plane(one plane).The surgical procedures were successful in all of the 62 cases without conversion to open operation.The mean operation time was(54.7±11.4)min,and the mean intraoperative blood loss was(50.5±12.1)mL,without transfusion case.After operation,there were 2 cases of vascular damage that were treated under laparoscopy,2 cases of lymphatic leakage and 1 case of incision fat liquefaction that were treated successfully with conservative measures,and no complications with Clavien grade≥3.Conclusion Transperitoneal LRN based on"one line,one plane"precise dissection technique guided by the genital vein is safe and feasible,which has the advantages of clear anatomical layers,satisfactory exposure of renal pedicle blood vessels,and fewer intraoperative and postoperative complications.

关 键 词：根治性肾切除 生殖静脉 精准解剖 肾肿瘤 

分 类 号：R73[医药卫生—肿瘤]