后腹腔镜肾切除5例

5 Cases of Retroperitoneal Laparoscopic Nephrectomy

目的评价后腹腔镜肾切除的临床价值.方法采用Trocar穿刺建立第一通道,镜推法建立后腹腔,钛夹处理良性无功能肾肾蒂、直线切割器处理肾癌肾蒂等方法对2例肾萎缩、2例肾结核、1例肾癌患者行后腹腔镜肾切除.结果5例手术均获成功,手术时间为95～180min,平均126min.术中出血50～200mL,平均110mL.所有患者均未输血,无腹腔脏器损伤、膈肌损伤、皮下气肿等并发症.术后1～2d下床活动,5～6d出院.随访1a,结核患者无结核播散,肿瘤患者无肿瘤种植及复发.结论后腹腔镜切除良、恶性肾病,具有创伤小、出血少、康复快等优点,是一种安全、有效的治疗方法.

Objective To evaluate clinical effectiveness of Retroperitoneal laparoscopic nephrectomy. Methods The first tract was established by Trocar puncture directly, the retroperitoneum was established by the method of IUPU, the vessels of nonfunctioning kidney were clipped by hemoclips and the vessels of renal cell carcinoma were cut off by linear cutter, 2 cases of renal atrophy, 2 cases of tuberculosis pyonephrosis and 1 case of renal cell carcinoma were performed retroperitoneoscopic nephrectomy by this method. Results All the operations were successful in 5 patients. The average operation time was 126 minutes （95 to 180 minutes） ; the average blood loss was 110 mL （50 -200 mL）. No case received blood transfusion. All patients had no such complications as abdominal organ injuries, diaphragmatic injuries, or subcutaneous emphysema etc. Patients began to ambulate out of the beds 1 - 2 days and were discharged 5 - 6 days after the surgery. At 1 - year follow - up, no dissemination of tuberculosis or implantation metastasis or recurrence of carcinoma was detected. Conclusions Retroperitoneal laparoscopic surgery for the benign or malignant renal diseases is a safe and effective therapeutic method, and has the advantages of less trauma and bleeding and rapid recovery etc.