超早期肾动脉阻断技术在复杂性腹腔镜肾脏手术中的应用

Application of direct access to the renal artery in high-complexity laparoscopic nephrectomy

随着腹腔镜技术的成熟和经验的积累,腹腔镜肾癌根治术已经成为局限性肾癌和部分局部进展性肾癌治疗的"金标准"。经腹腹腔镜肾癌根治术中采用经典或早期肾动脉阻断方法是不符合无瘤原则的,而采用超早肾动脉阻断方法(左侧经屈氏韧带从左肾动脉根部阻断、右侧经主动脉-下腔静脉间隙从右肾动脉根部阻断)能在尽少触碰瘤体的情况下完成肾动脉阻断,不仅最大程度地遵循了无瘤原则,而且在处理一些复杂性肾癌(如大肾癌、伴淋巴结转移、伴肾静脉癌栓、既往同侧肾手术史、外伤史、感染史、肾动脉变异等)也体现出明显优势。同时该方法还能扩展应用于其他比较复杂的肾(根治)切除手术中,如肾周严重侵犯的肾盂癌、巨大肾良性肿瘤、肾结核、感染性无功能肾等。超早期肾动脉阻断方法既遵循无瘤原则,又降低了复杂性腹腔镜肾脏手术的难度,值得临床推广。

As the laparoscopic technology developed and experience accumulated,laparoscopic radical nephrectomy has become the standard treatment of localized or partial locally advanced renal cell carcinoma.Classic or early ligature of renal artery violates Robson principle in varying degrees,but the technique of direct access to the renal artery,which is achieved at the level of the Treitz ligament on the left and interaortocaval space on the right,not only follows Robson principle best,but also has incomparable advantages on high-complexity and high risk renal cell carcinoma like large tumor,lymph node metastasis,prior surgery or infection of ipsilateral kidney,renal artery variation and renal vein thrombus.This technique also can be used in other renal disease like local advanced renal pelvic carcinoma,renal metastatic carcinoma,huge benign tumor,non-functioning kidney caused by nephrophthisis or renal infection.The technique should be popularized because it follows Robson principle and by which laparoscopic nephrectomy for high-complexity becomes easier.