后腹腔镜肾癌根治切除术180例经验总结

Retroperitoneal laparoscopic radical nephrectomy for renal carcinoma:an experience with 180 cases

目的：总结后腹腔镜肾癌根治性切除术的经验。方法：回顾性分析2001年1月-2007年1月间180例后腹腔镜肾癌根治性切除术患者的临床资料,总结经验,评价其临床疗效。结果：180例肾癌患者均经病理确诊,均为T1-T2期,左侧87例,右侧93例;肿瘤直径1.5-8 cm,平均（4.8±1.3）cm;均采用经后腹腔镜肾癌根治术。180例全部手术成功,手术时间56-90 min,平均（70±12）min;术中出血约70-1500 ml,平均（122±36）ml;1例右肾静脉损伤,但未改开放手术,7例腹膜损伤,1例膈肌损伤,2例皮下气肿,1例切口疝,6例切口愈合延迟。术后24-48 h开始进食,术后7-9 d出院。随访4个月至6年,失访41例,因其他原因死亡4例,肺转移2例,无穿刺孔种植转移。结论：后腹腔镜肾癌根治术具有术中创伤小、术后恢复快、疼痛小的优点,是一种安全、有效的治疗方法。

Objective：To summarize our experience on retroperitoneal laparoscopic radical nephrectomy （RLRN） in treatment of patients with renal carcinoma. Methods： The clinical data of 180 patients with renal carcinoma, who received RLRN from Jan. 2001 to Jan. 2007, were retrospectively studied. The experience was summarized and the clinical outcomes of patients were assessed. Results： All the 180 patients were pathologically confirmed to have T1-T2 phase renal carcinomas, with 87 cases had left side lesions and 93 had right ones. The diameter of tumors was 1.5-8 cm, with a mean of （4.8±1.3）cm. All the patients were subjected to RLRN and all underwent successful operation. The operation time was 56-90 min, with a mean of （70±12） rain; the blood loss was about 70-1 500 ml, with a mean of （122 ±36） mL One patients had right renal venous injury （not converted to open surgery）, 7 patients had pleural injury, I had diaphragmatic injury, 2 had subcutaneous emphysema, I had incision hernia, and 6 had delayed union of incision. The patients began oral intake of food 24-48 h after operation and were discharged 7- 9 days after operation. Forty-one patients were lost during the follow up （4 months to 6 years） ; 4 patients died clue to other reasons and 2 had pulmonary metastasis. There was no puncture site metastasis in this group. Conclusion： RLRN has the advantages of less trauma, rapid recovery, and slight pain. It is a safe and effective method for treatment of renal carcinoma.