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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