超早期肾动脉阻断技术在经腹腹腔镜肾癌根治术中的安全性及可行性研究

Direct access to the renal artery for transperitoneal laparoscopic radical nephrectomy:the safety and feasibility

目的比较经腹腹腔镜肾癌根治术中不同的肾动脉阻断技术,评价超早期肾动脉阻断技术的安全性及可行性。方法 2008年5月至2010年12月间,由我院泌尿外科同一手术组共完成64例T1N0M0～T2N0M0期经腹腹腔镜肾癌根治术,其中按标准方式分离并阻断肾动脉者33例(A组),经Treitz韧带(左侧)或经主动脉-下腔静脉间隙(右侧)超早期阻断肾动脉者31例(B组),两组患者间临床基本参数(年龄、性别构成、体质指数、既往腹部手术史、肿瘤侧别、肿瘤最大径、术前TNM分期等)的差异无统计学意义。结果 A组1例患者因肾周广泛粘连,分离过程中因出血较多转开放,其余患者均成功实施经腹腹腔镜肾癌根治手术。两组患者间手术时间、术中出血量、术中及术后并发症、术后TNM分期、术后禁食时间、术后引流管留置时间、术后住院时间、病理类型等差异均无统计学意义,但B组T2期患者术中出血量少于A组(P<0.05)。结论经腹腹腔镜肾癌根治术中采用超早期肾动脉阻断技术是安全可行的,既遵循了无瘤原则又能减少T2期肾癌术中出血,且在一定程度上拓宽了肾癌腹腔镜手术的适应证。

Objective To compare different methods for blockage of renal artery in transperitoneal laparoscopic radical nephrectomy,and evaluate the safety and feasibility of direct access to the renal artery.Methods From May 2008 to December 2010,64 patients with T1N0M0-T2N0M0 stage renal carcinoma underwent transperitoneal laparoscopic radical nephrectomy using a standard procedure to isolate and block renal artery（group A,33 patients） or a direct access to the renal artery via ligament of Treitz（left side） or aorta-inferior vena cava（right side;group B,31 patients）.The age,gender,body mass index（BMI）,history of previous abdominal surgery,tumor side,tumor maximum diameter,and preoperative TNM stages were all matchable between the two groups.Results One patient in group A was conversed to open surgery due to extensive perirenal adhesion and the others successfully received transperitoneal laparoscopic radical nephrectomy.The operation time,estimated blood loss,intraoperative and postoperative complications,postoperative TNM stage,postoperative fasting time,postoperative indwelling time of drainage tube,postoperative hospital stay and pathological types were similar between the two groups.Patients with T2 stage tumors in Group B had less intraoperation blood loss than those in Group A（P0.05）.Conclusion Direct access to the renal artery is feasible and safe of transperitoneal laparoscopic radical nephrectomy.The method not only fulfils the tumor-free principles and reduces intraoperative blood loss,but also broadens the indications of laparoscopic operations for renal cell carcinoma.