腹腔镜下肾癌根治术

Transperitoneal laparoscopic radical nephrectomy

目的 探讨经腹入路腹腔镜下肾癌根治术的手术方法。方法 3 8例肾癌患者施行了手术 ,患者采用全侧卧位 ,用 3～ 4个套管针 ,镜下切开侧腹膜显露肾周筋膜前面 ,在肾动静脉根部分别用线结扎及钛夹钳夹后切断 ,低位切断输尿管 ,沿肾筋膜外完整切除肾脏及肿瘤 ,清扫肾门旁、腹主动脉及下腔静脉旁淋巴结 ,小切口取出肾脏。结果 手术时间 75～ 2 5 0min ,平均 110min ;出血 5 0～ 3 0 0ml,均未输血。术后恢复良好 ,疼痛较轻 ,无明显并发症。结论 经腹入路腹腔镜下肾癌根治术 ,术中暴露良好 ,便于肾动静脉处理及淋巴结清扫 ,肾筋膜外切除肾脏完整取出符合肿瘤治疗原则 ,可减少种植转移。

Objectives The present study evaluated the feasibility of the laparoscopic radical nephrectomy in patients with renal cell carcinoma(RCC).Methods Thirty-eight patients with clinically localized RCC were performed laparoscopic radical nephrectomy.The patient was positioned in a lateral decubitus position with a four-trocar technique.After reflection of colon and identification of the renal hilum,the renal artery and vein were dissected proximally.The ureter was transected as distal as possible.Following the Gerota's fascia,the kidney was fully mobilized.Then a complete regional lymphadenectomy was performed.Subsequently:the kidney together with the tumor was removed through an abdominal incision.Results The mean(range) duration of surgery was 110(75～250) minutes;the blood loss was 50～300 ml. The postoperative results of the laparoscopic radical nephrectomy are comparable to that of open surgery with much less pain and shorter convalescence.Conclusions The transperitoneal route of laparoscopic radical mephrectomy affords an optimal working space and facilitates orientation by providing readily identifiable anatomic landmarks.Removal of the kidney outside Gerota's fascia is still the most important aspect of laparoscopic radical nephrectomy,and it can ultimately prevent port site seeding.