后腹腔镜根治性肾切除术治疗局限性肾癌(附96例报告)

Retroperitoneal Laparoscopic Radical Nephrectomy for Localized Renal Carcinoma(A Report of 96 Cases)

目的:探讨后腹腔镜根治性肾切除术治疗局限性肾癌的手术方法及其临床效果。方法:2005年1月～2010年6月采用气囊扩张建立后腹腔及Hem-o-lok处理肾动静脉的方法行后腹腔镜根治性肾切除术96例。肿瘤大小(1.5～10.0)em,左侧37例,右侧59例。结果:手术时间为60～300min,平均135min;术中出血量50～600ml,平均120ml;术后肠道恢复时间0.5～3天,平均1.5天;术后住院5～10天,平均8.4天。1例患者因出血较多输血,所有患者均无严重并发症发生。术后病理分期:T1N0M078例、T2N0M018例。术后随访3～36个月,平均12个月,1例术后10个月发生肝转移死亡,1例术后2年发生肺、骨转移而死亡,其余病例无瘤生存。结论:后腹腔镜根治性肾切除术具有创伤小、术后恢复快、并发症少等优点,是治疗T1～2N0M0局限性肾癌患者的一种安全、有效的方法。

Objective：To investigate the surgical technique and clinical efficacy of retroperitoneal laparoscopic radical nephrectomy （LRN） for localized renal cell carcinoma.Methods：From January 2005 to June 2010,a total of 96 patients with localized renal carcinoma underwent retroperitoneal LRN,retroperitoncal space was structured with balloon dilatation,and Hem-o-lok clips were used to control renal vessels during operation.The tumors sized 1.5～10.0cm in diameter.Thirty-seven rumors were on the left kidney and 59 on the right side. Rcsults：The operation time was 60～300min ｜mean.l35min）,the blood loss was 50～600ml（mean,120ml）,the time of recovery of bowel function was 0.5～3d（mean,1.5d）,and the postoperative hospital stay was 5～10d（mean,8.4d）.Only one patient needed blood transfusion,and there were no serious complications occurred in all cases.Seventy-eight patients were in stage T1N0M0.and 18 in stage T2N0M0.The patients were followed up for 3～36 months（mean,12 months）,one patient died of liver metastasis 10 months after operation,and one died of lung and bone metastasis 2 years postoperatively,and the other patients survived without tumor.Conclusion：Retroperitoneal LRN has the advantages of mini-invasion and rapid recovery,and is the safe and effective method of treatment for patients with T1～2N0M0 renal carcinoma.