经腰部切口锐性分离根治肾癌

Technical improvements in open radical nephrectomy with renal carcinoma

目的:探讨改进经腰肾癌根治术的方法,提高手术安全性和手术治愈率。方法:对310例肾癌患者选择经腰入路(11肋、12肋或11肋间)切口,显露肾区后,沿腰方肌外缘纵行切开侧锥筋膜与腰方肌筋膜的延续部,在肾周筋膜外按肾后、上、前顺序,解剖性锐性分离肾周筋膜后间隙和前间隙,分离肾上极,游离肾血管,分别结扎肾动脉和肾静脉,在肾周筋膜外将肾脏及肿瘤完整切除。结果:310例手术经过均顺利。手术时间为60～145min,平均90min;出血量30～300ml,平均50ml。5例出现并发症,其中2例为胸膜损伤,1例为腔静脉损伤出血,2例术后4～6h肾窝慢性出血休克,均经修补和再手术好转;281例(91%)患者得到随访1～36个月,无一例肾窝复发。结论:经腰切口,在肾癌根治术中,按解剖层次锐性分离是一种安全有效的根治术式。

Objective：To evaluate the effect of technical improvements of open radical nephrectomy with renal carcinoma. Mcthods：Technical improvement included nephrectomy with choosing lumbar incision and expose the nephridium, cut open the stretch board between lateral conal fascia and lumbar quadrate muscle fascia along the outer margin of quadratus lumborum. According to the sequence of post-upper-fore, dissociate anatomically anteri or and posterior diastema of perirenal fascia. Isolate the vessel of kidney, and successively ligture renal arteries and veins, then remove kidney and tumor. Results：310 patients who account for 91% in the synchronization received this kind approach. All tumor diameter was less than 10 cm, stage Ⅰ account 69%0, stage Ⅱ 30%0, stage Ⅲ 1%, stage Ⅳ 3%. The mean time of operation was 90 minutes, and the mean bleeding quantity was 50 ml. 5 patients had complications, among them, two cases was injury of pleura, one was injury of vein cava and bleeding, the other two cases emerged shock due to chronic bleeding during 4-6 hours after operation. 281 patients （91%） had no recarrence in the nephridial pit after 1- 36 months follow-up. Conclusions： Anatomical and sharp radical nephrecto my through lumbar approach is an effective and safe radical method for renal cancer.