后腹腔镜根治性肾癌切除术

Retroperitoneoscopic radical nephrectomy

目的评价后腹腔镜下肾癌根治术的安全性及疗效。方法2002年11月～2004年7月于后腹腔镜下行肾癌根治术56例。男34例,女22例;年龄23～86岁,平均58岁。3例因无痛性全程肉眼血尿就诊,余53例为B超体检发现。所有患者腹部均未触及肿物。B超检查报告肿物直径1.5～8.0cm,平均4.5cm,肿瘤位于肾上极27例,肾中部13例,肾下极16例。56例均行CT检查,41例行MRI检查,报告肿物大小均与B超相符,术前临床分期:TlN0M03例,T2N0M048例,T3aN0M05例。结果该组手术时间60～255min,平均145min;出血量20～800mL,平均133mL;32例肿瘤位于肾上极、瘤体>6cm、肿瘤与肾血管关系紧密者均行肾上腺切除。3例发生手术并发症,其中1例为生殖腺静脉损伤,出血约800mL转开放手术;1例用直线切割器切右肾静脉时,误将腔静脉切割封闭了一半,但未出血;1例为直线切割器切断肾动脉后残端喷血,用钛夹止血。病理报告:肾透明细胞癌51例,囊性肾细胞癌2例,嫌色细胞癌1例,错构瘤1例,嗜酸细胞瘤1例。随访1～20个月,平均9个月,1例因肾癌肝转移,于术后1年死亡,其余病例仍无瘤生存。结论后腹腔镜下肾癌根治术安全可靠,疗效良好。

[Objective] To evaluate the safety and efficacy of retroperitoneoscopic radical nephrectomy. [Methods] A total of 56 patients （34 males and 22 females; age range, 23-86 years; mean age, 58 years） underwent retroperitoneoscopic radical nephrectomy from November 2002 to July 2004. Of the 56 cases, 53 were detected by B-ultraseund during physical examination and the rest 3, when visiting doctors due to painless hematuria. The masses by B-ultrasound was on average 4.5cm （range, 1.5-8.0cm） in diameter. With 27 masses at the upper pole of the kidney, 13 at the middle and 16 at the inferior pole. CT scan was performed on all the 56 cases and MRI on 41. The tumor size detected by CT and MRI was consistent by B-ultraseund. Preoperatively, 3 cases had the tumors of clinical stage T1N0M0, 48 of T2N0M0 and 5 of T3aN0M0. [Results] The operative time was 60-255 min （mean, 145 min）, and blood loss was 20-800 mL （mean, 133 mL）. Adrenaleetomy was performed on 32 patients （70%）. Complications occurred in 3 eases, of whom only 1 required conversion to open surgery due to injury of genital gland vein, with blood loss of 800 mL. Pathology showed that 51 eases were of renal clear cell carcinoma, 2 of cystic renal cell carcinoma, 1 of ehromophobe carcinoma, 1 of hamartoma and 1 of oxyphil cell tumor. During the follow-up of 1-20 months （mean, 9 months）, 45 patients survived; only 1 died of liver metastasis. [Conclusions] Retroperitoneoscopy radical nephreetomy is safe and effective.