腹腔镜根治性肾切除术

Laparoscopic radical nephrectomy

目的探讨腹腔镜下根治性肾切除的手术方法和临床应用价值。方法分析总结50例腹腔镜根治性肾切除术治疗肾癌的临床资料。18例采用了经腹腔途径,32例采用了经腹膜后途径。腹腔镜下切断肾动静脉,在髂血管分叉处切断输尿管,沿肾周筋膜外游离切除整个肾脏,扩大切口后取出标本。结果经腹腔途径手术1例因肾静脉撕裂中转为开放手术,余49例手术获得成功。手术80￣150min,平均103.6min,术中出血50￣300mL,平均155.6mL,术后住院4￣7d,平均5.4d。46例患者术后随访2￣32个月,1例术后5个月发现肺转移,局部无复发,余患者均无瘤生存。结论腹腔镜根治性肾切除术是一种安全、有效的手术方法,具有创伤小、术后恢复快、并发症少等优点。此术式是治疗T1-T2N0M0期肾癌患者的较好方法。

[Objective] To evaluate the method and the clinical value of laparoscopie radical nephrectomy. [Methods] 50 cases of renal cell cancer treated with laparoseopic radical nephrectomy between January 2002 and December 2004 were reviewed. The 18 cases were operated on transperitoncally and the other 32 retroperitoneally. The renal artery and vein were exposed and dissected under laparoscopic vision firstly. Then the ureter was identified and dissected. The renal was dissected from the surface of Gerota＇ s fascia, The specimen was removed from the working place through an additional incision. [Results] One case was changed to open operation due to rupture of renal vein while the other 49 cases were all successful. The mean operative time was 103.6 minutes （range from 80 to 150）; the mean estimated blood loss was 155.6 mL （range from 50 to 300）; the mean postoperative stay was 5.4 days （range from 4 to 7）. Follow-up was between 2 and 32 months with an average of 18.6 months in 46 cases. Pulmonary metastasis was observed in 1 case after 5 months. No cases of local recurrence occurred during observation. [Conclusions] Laparoscopic radical nephreetomy is a safe and effective surgical technique. The less trauma, short recovery time and low complications are the characteristics of this minimal invasive surgery. Laparoscopie radical nephrectomy provides an alternative means to treat the patients with pT1-T2N0M0 renal cell carcinoma.