目的：介绍后腹腔镜下解剖性根治性肾切除术的手术方法及临床效果。方法对187例肾癌患者实施后腹腔镜下解剖性根治性肾切除术。其中左侧103例，右侧84例；肿瘤最大径2.0~8.2 cm，平均4.6 cm；所有患者均常规制备后腹腔间隙，按顺序分别进入相对无血管解剖层面进行分离，腰大肌为背侧标志，膈肌为肾上极后侧标志，肾上腺为肾上方内侧标志，腹膜为腹侧标志，下腔静脉与腹主动脉是内侧的标志，髂血管是 Gerota 筋膜锥尖部的解剖标志。结果所有手术均获成功，无中转开放手术，术中无明显并发症发生。手术时间90~150 min，平均110 min；出血60~100 ml，平均75 ml；恢复饮食和下床活动时间分别为 l.3 d 和1.2 d；术后3~7 d 出院。142例患者术后随访6~42个月，其中1例出现腹膜后淋巴结转移，余经 B 超及胸片检查未见局部复发或远处转移。结论后腹腔镜下解剖性根治性肾切除术具有解剖层次清楚，术中出血少，术野清晰，疗效确切，并发症少，恢复快等优点，为需要根治性肾切除术的患者提供了更好的选择。%Objective To introduce the technique and clinical effect of anatomical retroperitone-al laparoscopy radical nephrectomy. Methods A total of 187 patients underwent anatomical retroperito-neal laparoscopy radical nephrectomy. Among them,103 cases of tumor located in the left kidney and 84 cases located in the right kidney. The maximum diameter of tumor was 2. 0 to 8. 2 cm,with an average di-ameter of 4. 6 cm. Retroperitoneal space was created routinely at lateral decubitus position. Relatively bloodless planes were orderly entered for exposure and separation of the kidney outside Gerota’s fascia. In the first place,the greater psoas was identified as the dorsal marker. Then the diaphragmatic muscle was identified as the posterior mark of the upper pole of the kidney,and the adrenal gland as the medial marker of the upper pole of the kidney,and the peritoneum as the ventral maker,and the inferior vena cava and abdominal aorta was the medial marker. Iliac blood vessels was the mark of Gerota’s fascia cone tip. Results All operations were successful,with no case transferred to open operation. No case had blood transfusion and severe complications during surgery. The mean operative time was 110 min (range from 90 to 150 min). The mean intraoperative blood loss was 75 ml(range from 60 to 100 ml). Average days to oral intake and ambulation were 1. 3 and 1. 2 days. All patients discharged from hospital on 3 to 7 days after surgery. One hundred and forty-two patients were followed-up for 6 to 42 months. Only one case suffered from retroperitoneal lymph mode metastasis. Others had no local recurrence or dis-tant metastasis by ultrasound and chest X ray inspection. Conclusions Anatomical retroperitoneal lapa-roscopy radical nephrectomy is a safe and effective procedure. It can decrease operation time,blood loss and complication rates effectively,and provide a better choice for the patient whom demand radical ne-phrectomy.
展开▼
