后腹腔镜下解剖性肾切除术的疗效观察(附63例报告)

Anatomical retroperitoneoscopic radical nephrectomy: Outcomes of 63 cases

目的：探讨后腹腔镜下解剖性肾切除术的临床疗效与手术技巧。方法：对我院自2009年2月～2013年10月间63例行后腹腔镜下肾切除术的患者临床资料进行回顾性分析，并统计手术时间、术中出血量及术中术后并发症，观察手术效果。结果：除1例因术中严重粘连而中转开放手术外，其余62例均成功在腹腔镜下完成手术。手术时间70～485 min，平均（238．0＆#177;94．8）min，术中出血量20～1200 ml，平均（196．0＆#177;238．0）ml，术中3例输血，1例结核肾术中破溃，术后1例出现创面渗血，经处理于术后1周治愈，1例肾癌术后发生远处转移，1例术后出现肾功能不全。结论：后腹腔镜解剖性肾切除术具有创伤小、恢复快、解剖清晰等优点，是一种安全、有效的手术方法，值得应用推广。

Objective：To evaluate the clinical efficacy and investigate the surgical technique for anatomical retroperitoneoscopic radical nephrectomy . Methods：The clinical data were retrospectively analyzed in 63 cases undergone anatomical retroperitoneoscopic radical nephrectomy in our hospital between February 2009 and October 2013 regarding the operating time,intraoperative blood loss,postoperative complications and outcomes.Results：The operation was successfully performed in 62 cases except for one case required referral to open surgery due to severe adhesion .The operating time ranged from 70 to 485 min,mean（238.0 ＆#177;94.8）min,and intraoperative blood loss varied between 20 and 1 200 ml,mean（196.0 ＆#177;238.0） ml.Three cases re-quired blood transfusion during the operation.Kidney rupture occurred intraoperatively in one case from renal tuberculosis and postoperative dissection bleeding occurred in another one that was cured in one week time .One patient had distant metastasis of renal tumor and another one had renal dysfunction after surgery.Conclusion：Anatomical retroperitoneoscopic radical nephrectomy has the advantages of minimal invasion ,early recovery and clear dissection in operation,and is of wider clinical application for its safety and efficacy .