膈肌内侧弓状韧带在后腹腔镜肾切除术中的应用效果

Application effect of the diaphragm medial arcuate ligament in retroperitoneal laparoscopic nephrectomy

目的探讨膈肌内侧弓状韧带在后腹腔镜肾切除术中的应用效果。方法选取我院2015年6月至2016年12月收治的38例行肾切除术的患者,其中肾癌患者24例,多因素导致肾功能严重障碍、肾萎缩患者14例,上述38例患者均通过膈肌内侧弓状韧带寻找肾动脉,并予以肾脏游离,观察38例行肾切除术患者的肾动脉显露时间、手术时间、出血量及中转情况。结果38例予以肾切除术患者的肾动脉显露时间为(16.87±3.41)min,肾切除手术时间为(86.27±6.18)min,出血量为(35.51±11.32)m L,中途未予以输血措施,无中转开放。结论后腹腔镜下可将膈肌内侧弓状韧带清楚显示,其内弓状韧带于水平中线方向行走,正对于肾动脉,于内侧弓状韧带为定位靶标,可迅速找到肾血管,故临床中遵循"宁少勿多"原则将肾后间隙游离,可将肾血管清晰显露,以减少操作通道数量,其膈肌内侧弓状韧带在后腹腔镜肾切除术中的应用效果显著,可借此迅速找到肾动脉,减少手术时间,降低术中出血量,保证患者的生命安全。

Objective To investigate the application effect of the diaphragm medial arcuate ligament in retroperitoneal laparoscopic nephrectomy. Methods A total of 38 patients admitted in our hospital from June 2015 to December 2016 were enrolled in the study. Among them, 24 patients were with renal cell carcinoma, and 14 patients were with severe renal dysfunction or renal atrophy leaded by various factors. The renal arteries of the above 38 patients was found through the medial arcuate ligament of the diaphragm, and the kidneys were separated. The time of renal artery exposure,nephrectomy operation time, intraoperative blood loss and incidence of transfer of 38 patients who received retroperitoneal laparoscopic nephrectomy were observed. Results The time of renal artery exposure was（16.87 ±3.41） min, nephrectomy operation time was（86.27±6.18） min, and the intraoperative blood loss was（35.51 ±11.32） m L. No blood transfusions and no transfer were found. Conclusion The retroperitoneal lacrimal ligament can clearly show the internal ligament of the diaphragm, which is in the direction of the horizontal midline, and the renal artery is located on the medial bow ligament.The renal artery can be found quickly. The posterior pararenal spaces is freed in accordance with the principle of ＂better less than more＂, and renal blood vessels can be clearly revealed in order to reduce the number of operating channels.The diaphragm medial arcuate ligament in retroperitoneal laparoscopic nephrectomy has significant effect, it can shorten the operation time and reduce the intraoperative blood loss to ensure the safety of patients.