后腹腔镜肾切除术的安全性及疗效评估(附1000例报告)

Safety and efficacy of retroperitoneoscopic nephrectomy(Report of 1000 cases)

目的：总结本组后腹腔镜肾切除术的经验，评价该手术的安全性及疗效。方法：回顾性分析本组2004年3月～2012年4月1000例后腹腔镜肾切除术患者的临床资料。男537例，女463例。平均年龄57（16～86）岁。根治性肾切除术645例，肾输尿管全长切除术245例，单纯性肾切除术110例。结果：中转开放手术14例。平均手术时间110（70～320）min（不包括肾输尿管全长切除术中输尿管末端的处理），平均术中出血量为80（20～830）ml。术后平均肠功能恢复时间23（18～43）h，术后平均下床活动时间24（19～47）h，术后拔除引流管平均时间50（36～72）h，术后平均住院时间7（5．5～10．0）d。输血15例。术中静脉损伤8例，动脉损伤4例；术后6例发生严重并发症。结论：后腹腔镜肾切除术适应证广、手术效果好，但仍有发生严重并发症的可能性。

Objective： To evaluate the safety and efficacy of retroperitoneoscopic nephrectomy. Method： The retrospective analysis was performed on 1 000 consecutive patients underwent retroperitoneoscopic nephrectomy from March 2004 to April 2012. There were 537 male and 463 female patients with the average age of 57 （16-86） years. Radical nephrectomies were performed for 645 patients while ureteronephrectomies for 245 patients and simple nephrectomies for n0 cases. Result： Fourteen cases were converted to open surgery due to severe adhesion and severe bleeding. The mean operative time was 110 （70-320） rain （except for excision of the end of ureter in ureteronephrectomy）. The medium estimated blood loss was 80 （20-830） ml. The mean drainage time was 50 （36- 72） h. The mean time of recovery of intestinal function was 23 （18-43） h and the mean postoperative hospital stay was 7 （5.5-10.0） d. Fifteen cases required blood transfusion, lntraoperative complications mainly include four re- nal artery iniuries and eight vein injuries. There were six patients with severe complications postoperatively. Con- clusion： Despite of potential complications retroperitoneoscopic nephrectomy is safe and effective.