后腹腔镜肾切除术78例临床体会

Reports of 78 cases with retroperitoneal laparoscopic nephrectomy

目的:探讨后腹腔镜在肾切除治疗中的临床应用价值。方法:对78例患者行后腹腔镜肾脏切除术。单纯肾切除51例,肾癌根治术14例,联合尿道电切镜肾输尿管全切除13例。肾脏肿瘤14例,结核性脓肾6例,上尿路结石(33例)、UPJO(3例)引起巨大肾积水并感染36例,开放手术后输尿管中、上段闭锁并肾积脓5例,无功能萎缩肾3例,肾盂癌11例,输尿管癌2例,左肾出血1例。术前均行B超、IVU、CT或MR I检查,健侧肾功能正常。肾脏恶性病变TNM分期:T1～T2N0M0。观察手术时间、术中出血量、住院时间、术中术后并发症及手术效果。结果:除2例肥胖患者因严重粘连、1例大出血中转开放手术外,75例手术均成功。术中损伤肾静脉2例、损伤下腔静脉属支生殖静脉1例,均在腔镜下妥善处理。手术时间40～260 m in,平均73 m in。术中出血量30～850 mL,4例输血。75例肠功能恢复时间18～48 h,均在术后第1 d下床活动。引流管拔除时间24～72 h,术后住院时间7～12 d,平均8.5 d。27例肿瘤病人随访2～60个月,1例于术后6月发现腹膜后转移,现带瘤存活;1例肾癌于术后18个月死于肿瘤全身多处转移,其余25例患者均无瘤生存。结论:后腹腔镜肾切除术具有创伤小、恢复快、疗效可靠的特点,具有良好的临床应用前景。

Objective：To discuss the clinical application and effect of retroperitoneal laparoscope in nephrectomy.Methods：78 cases were performed retroperitoneal laparoscopic nephrectomy from April 2003 to June 2009,including 51 cases of simple nephrectomy,14 cases of radical nephrectomy and 13 cases of total nephroureterectomy with excision of bladder cuff.Of these cases,14 cases were renal tumors,6 cases were tuberculosis pyonephrosis,36 cases were giant hydronephrosis and infection kidneys caused by the stones（33 cases） and ureteropelvic junction obstruction（3 cases）,5 cases were ureteral clausuras and pyonephrosis caused by the open surgery,3 cases were non-functioning and atrophic kidneys,11 cases were renal pelvic carcinomas and 2 cases were ureteral carcinomas,one cases was nephrorrhagia.B-ultrasound,IVU,CT and MRI were performed before operation in all cases.Malignant renal neoplasms clinical stage was all T1-T2N0M0.The operative time,blood loss,peri-operative complications and operative effects were evaluated.Results：75 operations were successful except 2 obese cases and one case occured loss bleeding.2 cases had renal venous injury and one case had vena genitalis injury,which were all treated appropriately by endoscopic methods.The mean operative time was 73 minutes（ranged 40 mins to 260 mins）.The blood loss was 30~850 mL and 4 patients received blood transfusion.75 cases had no obvious complications.The time of disposing of drainage tube was 24~72 h.Postoperative intestinal function recovery time was 18~48 h.The mean postoperative hospital stay was 8.5 days（ranged from 7 days to 12 days）.Followed up from 2 to 60 months,one case survived with retroperitoneal metastasis tumor at posteroperative 6 months.One renal tumor patient died from multiple metastases at posteroperative 18 months and 25 cases survived with no metastasis.Conclusion：Retroperitoneal laparoscopic nephrectomy is proved to be effective with minimal invasion and quicker recovery procedure.It can partly take the place of conventional open surgery and it has a good prospect in the urologic clinical practice.