177例后腹腔镜肾根治性切除的临床分析

Clinical analysis is 177 cases underwent retroperitoneal laparoscopic nephrectomy

目的腹腔镜技术在泌尿外科的应用已逐渐受到重视,但临床中较为严重的并发症时有发生,文中对后腹腔镜下肾根治性切除的手术方法、合并症及治疗效果进行探讨。方法 177例肾癌均采用后腔路径行根治性肾切除术。结果全组手术时间36~190m in,平均（65.6±29.5）m in;出血量30~1500m l,平均（75±20）m l。并发症9例：术中大出血5例,其中副肾动脉、下腔静脉损伤各1例,中转开放;肾蒂滑脱1例,经重新结扎肾蒂而止血;精索静脉损伤2例,出院1~2月后自行吸收。高碳酸血症4例,经加大氧通气量、暂停气腹得到有效解救。切口引流2~5 d拔除。患者术后第2天下床活动。患者术后住院4~14 d,平均6.3 d。术后随访3~30个月,患者全部生存,无一例肿瘤复发,无切口种植与远处转移。结论肾腹腔镜肾根治性切除术创伤小,恢复快、效果好。采用三重双向Hem-o-leck结扎锁处理肾蒂安全可靠,具有良好的临床应用前景。

Objective As the application of laparoscopic surgical procedures in urology surgery widespreaded,serious complications occurred sometimes.The purpose of this article is to investigate the methods,applications and outcomes of laparoscopic radical nephrectomy in our deparment and make further discussion.Methods Analysis 177 cases underwent laparoscopic radical nephrectomy. Results In 36-190 minutes（65.6±29.5） operation time and amount of 30-1500ml（75±20） bleeding,9 complications occurred,including 5 cases of intraoperative bleeding involved in renal artery disposition,1 case of accessory renal artery and inferior vena cava injured respectively,transit open surgery,1 cases of renal pedicle detachment,bleeding stopped after religation,2 cases of spermatic vein injured,absorbed 1-2 month later after discharge.4 cases of hypercapnia resulted form excessive volume of oxygen ventilation and moratorium pneumoperitoneum were effective rescued.Incision drainage extracted after 2-5d.All were up and activityed the second day.Hospital stay of postoperative was 4-14d with an average of 6.3d.All potoperative survive according a 3-30 months follow-up and no reported case of tumor recurrence,distant metastasis and cultivation incision. Conclusion Laparoscopic radical nephrectomy have advantages of rapid recovery and efficiency.It＇s safe and reliable to ligate renal pedicle using two-way trilpe-Hem-o-leek lock in the opration.Laparoscopic surgical procedures should be well operated to avoid applications and make good use for clinical management.