后腹腔鏡根治性腎切除術(shù)的臨床應(yīng)用

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1、中華腔鏡外科雜志(電子版)2009年12月第2卷第1期ChinJLaparoscopicSurgery(ElectronicEdition)，December2009，Vol2，NO．1·32臨床研究●后腹腔鏡根治性腎切除術(shù)的臨床應(yīng)用趙杰【摘要】目的探討后腹腔鏡根治性腎切除術(shù)的可行性、安全性及臨床療效。方法2003年3月至2008年2月行后腹腔鏡根治性腎切除術(shù)52例。男29例，女23例。年齡24～78歲，平均年齡57歲。右側(cè)27例，左側(cè)25例。無痛性全程肉眼m尿8例，其余44例為超聲體檢發(fā)現(xiàn)。腫瘤的大小1．5cmx1．8cm～8．7cmx9．2cm，平均3．6cmx4．3cm

2、。腫瘤位于腎上極l9例，腎中部l5例，腎下極18例。52例均行CT檢查，l9例行MRI檢查。術(shù)前臨床分期：TlN0M05例，T2N0M045例，T3aN0M02例。結(jié)果52例均獲成功，無中轉(zhuǎn)開放手術(shù)患者，有l(wèi)3例腹膜破裂，有6例術(shù)后肩部隱痛，有4例切口皮下氣腫，患者均在短期恢復(fù)。術(shù)后均無使用鎮(zhèn)痛劑。手術(shù)時間90~230min，平均l52min：出血量50~200ml，平均l20ml；術(shù)后住院時間6~9d，平均7．5d。術(shù)后病理報告：腎透明細胞癌49例，囊性腎細胞癌2例，腎顆粒細胞癌1例。隨訪6~36個月，平均l5個月，未見腫瘤復(fù)發(fā)。結(jié)論后腹腔鏡根治性。腎切除術(shù)安全可行、療效肯

3、定。【關(guān)鍵詞】腎腫瘤；后腹腔鏡；腎切除術(shù)TheclinicalapplicationofretroperitoneallaparoscopicradicalnephrectomyZHA0．fie．ThefirstHospitalofXinxiangCity,Xinxiang453000,China[Abstract]ObjectiveToexplorethefeasibility，safetyandclinicalefectofretroperitoneallaparoscopicradicalnephrectomy．Methods52patients(29males，23f

4、emales)withmeanageof57yearsrange(24-78years)underwentretroperitoneallaparoscopicradicalnephrectomyfrommarch2003tofebruary2008．27caseslocatedintherightand25caseslocatedintheleft．8caseswerepainlesswholecoursegrosshematuria，andother44caseswerefoundbyultrasonicphysicalexamination．Thetumorsizera

5、ngedform1．5cmx1．8cmto8．7cmx9．2cmmean(3．6cmx4．3cm)19caseslocatedintheupperroleofkidney,15caseslocatedinthemiddleroleofkidney,18caseslocatedinthelowerroleofkidney．52caseswereallbyCTseanand19caseswerebyMRIscan．Preoperativeclinicalstaging：5caseswereT1NoMo．45caseswereT21oM0and2caseswereT3aNoMoRe

6、sultsSuccesshadbeenachievedinallcasesandnopatientconversionstoopensurgery．13caseshadperitoneumrupture，6caseshaddullpaininshoulderpostoperativeand4caseshadsubcutaneousemphysemainincision．Thepatientswereallrecoveryinshorttime．Postoperativetherewerenouseanalgesics．Theoperativetimerangedfrom90t

7、o230minutesmean(152minutes)bleedingvolumerangedfrom50to200mlmean(120m1)Postoperativehospitalstayrangedfrom6to9daysmeanf7．5days)Postoperativepathologicalreports：49caseswererenalclearcellcarcinoma，2caseswerecysticrenalcellcarcinoma，1casewasrenalgranularcar