经腰第10肋间胸膜外切口在后腹腔肿瘤手术中的应用与技巧

Application and Surgical Techniques of Extrapleural Incision Above the 11th Rib in the Treatment of Retroperitoneum Tumors

目的探讨经腰部10肋间胸膜外切口在肾脏和肾上腺肿瘤手术中的临床应用价值.方法采用经腰部11肋上缘胸膜外切口,切断膈肌,将胸膜向上推开,扩大后腹腔空间,行肾癌和肾上腺肿瘤的手术.结果42例手术均获得良好的视野,肿瘤完整切除,无腔静脉及肾静脉的损伤,手术出血少,围手术期恢复良好.结论经10肋间胸膜外切口对肾癌及肾上腺肿瘤手术具有暴露充分、视野良好的优势.

Objective To introduce some new techniques in dealing with the retroperitoneum tumors through extrapleural incision above the 11th rib.Method Firstly we made a extrapleural approach incision above the 11th rib,then cut off the intercostal muscle and some of the diaphragmatic muscle,then pushed the pleura upward to get a good surgical vision,and lastly the tumors were moved out quite safely.Results 42 retroperitoneum tumors including 35 renal tumors and 7 adrenal tumors were excised totally in such way.There was no cases of venae cavae and renal vein injures.The blood loss was little during surgery and all patients recovered well in peri-operative period.Conclusion Extrapleural approach incision above the 11th rib is a good alternative in dealing with complicated retroperitoneum tumors,and this new technique provide better surgical vision especially in those big renal tumors and adrenal tumors surgery.