后腹腔镜肾癌根治术治疗43例肾癌的临床报告

Retroperitoneoscopic Radical Nephrectomy for Renal Cancer——A Report of 43 Cases

背景与目的:随着腹腔镜技术的发展,越来越多的肾癌患者接受腹腔镜手术的方法替代传统的开放手术,本研究介绍对后腹腔镜肾癌根治术的手术方法改良及疗效评价。方法:2003年11月至2006年8月使用免水囊扩张建立操作通道及Hem-o-lok结扎锁处理肾动静脉的方法行后腹腔镜肾癌根治术43例(简称腔镜组)。同时期行开放性肾癌根治术患者34例(简称开放组),比较两组疗效。结果:腔镜组与开放组手术时间比较差异无统计学意义(149minvs.140min,P=0.24),腔镜组术中出血量显著少于开放组(53ml vs.199ml,P<0.01),腔镜组术后肠功能恢复时间、引流管留置时间、下床活动时间及住院时间显著短于开放组(P<0.01),腔镜组术中、术后未发生明显并发症,开放组2例出现术后切口感染。随访1～32个月,腔镜组未出现复发或转移,开放组1例出现肺部转移。结论:后腹腔镜肾癌根治术具有创伤小、术后恢复快的优点,用免水囊扩张方法建立腹膜后操作通道安全可行,疗效可靠。用Hem-o-lok结扎锁处理肾动静脉安全可靠,经济实用。

BACKGROUND ＆ OBJECTIVE： With the development of laparoscopic technique, more and more renal cancer patients have accepted laparoscopic radical nephrectomy instead of open radical nephrectomy. This study was to introduce our experiences of retroperitoneoscopic radical nephrectomy, and evaluate its therapeutic efficacy. METHODS： Between Nov. 2003 and Aug. 2006, retroperitoneoscopic radical nephrectomy was performed in 43 renal cancer patients; retroperitoneal approach was structured without water balloon, and Hem-o-lok clips were used to control renal vessels during operation. In the same period, open radical nephrectomy was performed in 34 renal cancer patients. Treatment outcomes of the 2 groups were compared. RESULTS： There was no significant difference in operation time between laparoscopy group and open approach group （149 min vs. 140 min, P=0.24）. The amount of blood loss during operation was significantly less in laparoscopy group than in open approach group （53 ml vs. 199 ml, P〈0.01）. The time of intestinal function recovery, ambulation, indwelling drainage tube, and hospitolization stay after operation were significantly shorter in iaparoscopy group than in open approach group （P〈 0.01）. Incision infection occurred in 2 patients in open approach group; no severe perioperative complications presented in laparoscopy group. During the follow-up of 1-32 months, 1 patient in open approach group had lung metastasis; none in laparoscopy group had recurrence or metastasis. CONCLUSIONS. Retroperitoneoscopic radical nephrectomy has the advantages of mini-invasion and rapid recovery. The method of structuring retroperitoneal approach without water balloon is safe and effective. Hem-o- Iok clip is a reliable and economical device for renal vascular control.