经腹及经腰径路肾癌根治术的比较

A comparison of flank approach and transabdominal approach for radical nephrectomy

目的 比较经腰及经腹径路肾癌根治术。方法 分析 5年间 12 7例不同大小、不同部位、不同浸润程度肾脏肿瘤的手术径路和手术效果。结果 经腹手术病人 48例 ,其中肿瘤直径 <7cm 8例 ,肿瘤直径≥ 7cm 40例 ;肾上极及肾门区肿瘤 44例 ,肾下极肿瘤 4例 ;肿瘤累及肾周组织、血管 5例 ,伴有肾静脉癌栓 1例 ,腔静脉癌栓 1例。经腰径路手术病人 79例 ,其中肿瘤直径 <7cm 76例 ,肿瘤直径≥ 7cm 3例 ;肾上极及肾门区肿瘤 3 3例 ,均为直径 <7cm肿瘤 ,肾下极肿瘤 46例 ,1例肿瘤侵犯肾周组织。经腹手术主要并发症为脾损伤 ,本组 2例 ;经腰手术主要并发症为胸膜损伤 ,本组 5例。结论 直径≥ 7cm ,肾上极、肾门区肿瘤 ,可能已侵犯邻近组织 ,选择经腹径路 ;直径 <7cm ,肾下极肿瘤选择经腰径路。二种径路术中、术后并发症无明显差异。

Objective To compare the flank approach and t he transabdominal approach of radical nephrectomy.Methods 127 patients with different size,location and stage o f renal cell carcinomas were analyzed to compare the results of different approa ches of radical nephrectomy.Results 48 patients with renal cell carcinoma received radica l nephrectomy using transabdominal approach.Of these patients,8 patients each ha ve a tumor whose diameter is less than 7cm,other 40 patients’ tumor diameters a re 7cm or more.The tumors locate in the upper pole or the midportion of the kidn ey in 44 patients and other 4 patients have tumors located in the inferior pole of the kidney.5 patients’ tumors invade pararenal fat or vessels.One patient ha s renal venal tumor thrombus and one patient has vena caval tumor thrombus.79 pa tients received radical nephrectomy using flank approach.Of these patients,76 pa tients' tumor diameters are less than 7cm,3 palients' tumor sizes are 7cm or mor e.The tumors locate in the upper pole or the midportion of the kidney in 33 pati ents whose tumor sizes are less than 7cm.Other 46 patients have tumors located i n the inferior pole of kidney.One tumor invades pararenal fat.The main complicat ion of transabdominal approach is spleen injury,2 patients using transabdominal approach have this complication.The main complication of flank approach is pleur al injury and 5 patients using flank approach have this complication.Conclusions For patient who has a renal tumor of more than 7c m in diameter,tumor locates in the upper pole or midportion of the kidney and tu mor invades pararenal fat,the transabdominal approach is preferred.For patient w ith a tumor less than 7cm or the tumor locates in the inferior pole of the kidne y,the flank apporach is better.There's no difference of postoperative complicati ons between the two approaches.