后腹腔镜肾切除术肾蒂血管处理方法探讨(附39例报告)

The experience of vascular control of the renal pedicle in retroperitoneoscopic nephrectomies(Report of 39 cases)

目的:探讨后腹腔镜肾切除术中用腔内直线切割器(Endo-cut)和威克外科结扎锁(Hem-o-lok)处理肾蒂血管的安全有效性、经济性及优越性。方法:回顾性分析行后腹腔镜肾切除术39例,包括单纯性肾切除23例,根治性肾切除11例,肾输尿管全切除5例;其中用Endo-cut同时处理肾动、静脉18例,用Hem-o-lok分别处理肾动、静脉21例。结果:手术均获得成功,均未中转开放手术。1例Endo-cut离断肾动、静脉后残端严重渗血,近心端加用2个钛夹夹闭后未再渗血,其他处理肾蒂血管均顺利,术中、术后均未出现血管并发症。手术时间136～220min,平均160min;术中估计出血量60～320ml,平均125ml;腹膜后引流管于术后2～3天拔除,术后住院时间5～9天。结论:后腹腔镜肾切除术中用Endo-cut和Hem-o-lok处理肾蒂血管均安全有效,但Hem-o-lok更经济、便捷;对于肾蒂粘连严重,肾动、静脉无法游离者,用Endo-cut有优越性。

To introduce the experience of vascular control of the renal pedicle using endoscopic linear cutter （Endo-cut） or Hem-o-lok clips during retroperitoneoscopic nephrectomies. Methods： Thirty-9 retroperitoneoscopic nephrectomies （including 23 simple, 11 radical, and 5 nephroureterectomies） were performed by the same surgeon in our hospital. Arterial and venous control was achieved by application of Endo-cut （18 cases） or Hem-o-lok clips （22 cases）. Results： All the operations were performed successfully. None of the cases experienced conversion to open surgery. Only one case whose renal vessels were resected by Endo-cut occurred serious bleeding because of device malfunction. Additional two titanium clips were applied to effectively control the bleeding. The other cases didn＇t experience any clip-related complication during or after operation. The mean operative time was 160 rain （136 to 220 rain）, and the mean estimated bood loss was 125 ml （60 to 320 ml）. The retroperitoneal drainage tube was pulled out 2 or 3 days after the operation. The postoperative hospital stay was 5 to 9 days. Conclusions The methods of vascular control of the renal pedicle using endoscopic linear cutter （Endo-cut） or Hem-o-lok clips during retroperitoneoscopic nephrectomies both are safe and effective, Conclusions; Endo-cut, the Hem-o-lok is a more convenient and more economical device for vascular control. However, the Endo-cut is a better choice for cases that renal pedicle tissues were seriously adhered.