经腹解剖路径根治性肾切除术60例临床分析

Anatomical path of intraperitoneal radical nephrectomy： clinical experience of 60 cases

目的探讨经腹解剖路径根治性肾切除术的安全性及有效性。方法回顾性分析2007年3月至2009年12月郑州人民医院60例T2N0M0至T3N0M0期，经腹解剖路径根治性。肾切除术的手术过程及临床资料，统计分析手术时间、估计失血量、下床活动时间、胃肠功能恢复时间、止痛剂用量、引流量、引流管拔除时间、并发症发生率、术后住院日等。结果60例手术全部成功，无严重并发症及输血者，手术时间（106±23）min，估计失血量（112±37）ml；恢复饮食时间（2．1±0．7）d、下床活动时间（1．9±1．1）d，哌替啶用量（65±25）mg，引流量中位值100（50—300）ml，引流管拔除时间（3．6±1．3）d，术后平均住院日（9．4±2．1）d。结论经腹解路径根治性肾切除术具有解剖层次清晰、手术时间短、出血少、损伤少、术后恢复快、并发症发生率低等优点。

Objective To evaluate the safety and efficacy of intraperitoneal anatomical radical nephrectomy （IARN）. Methods A retrospective analysis was performed for 60 consecutive patients undergoing IARN at our hospital from March 2007 to December 2009. Various clinical parameters were collected and analyzed statistically. Results Sixty operations were performed successfully. There was neither conversion into open surgery nor blood transfusion. The mean operative time was （106 ± 23） rain, mean intraoperative estimated blood loss （ 112 ±37） ml, mean time of resuming oral intake （2. 1 ±0.7） d, mean time to ambulation （ 1.9 ± 1.1 ） d, mean postoperative analgesics （ pethidine ） dosage （ 65 ± 25 ） mg, average drainage volume 100（50 -300）ml, mean time of extracting drainage tube （3.6± 1.3 ）d and mean postoperative hospital stay （9.4 ± 2. 1 ） d. Conclusion IARN offers the advantages of distinct anatomical level, shorter operative time, less hemorrhage, less damage, faster postoperative recovery and a lower rate of complications.