精准解剖式肾前筋膜间平面腹腔镜肾癌根治手术的要点分析

Techniques and experiences of precise anatomical inter-prerenal-fascia planes in laparoscopic radical nephrectomy

目的介绍肾前筋膜间平面行腹腔镜根治性肾切除术(Ip LRN)的解剖要点及手术技巧。方法回顾性分析2010年10月至2017年5月在贵阳市第二人民医院及贵州医科大学附属医院泌尿外科收治的57例肾癌患者临床资料,术中采用基于层面外科肿瘤根治性切除的概念,评价Ip LRN手术过程,总结该手术应遵循的解剖平面理论。结果在Ip LRN手术过程中存在七个重要的外科平面,在这些无血管平面中游离,57例手术均获成功,术中未出现严重并发症,手术时间55~180min,平均68 min,出血量0~120 ml,平均19 ml,术后3~7 d出院,平均4 d。57例患者术后随访6~30个月,平均11个月,均无瘤生存。结论肾前筋膜间平面是Ip LRN手术的重要解剖层面,在肾癌根治术中解剖层次清晰,沿肾前筋膜间平面游离可避免解剖迷失,符合肿瘤学手术原则。

Objective To investigate the anatomical features and surgical techniques of interprerenal-fascia planes in laparoscopic radical nephrectomy（Ip LRN）. Methods Fifty-seven patients with renal cell carcinoma whom treated in urology department of the Second People＇s Hospital of Guiyang and the Affiliated Hospital of Guizhou Medical University during October 2010 to May 2017 were analyzed retrospectively. Based on the conception of trans-interfascial plane surgery associated with tumor radical resection, the process of the surgery was evaluated and the anatomical plane theory of the Ip LRN surgery was summarized. Results There were seven important surgical planes in the process of Ip LRN surgery. Fifty-seven cases were all successfully anatomized in these vascular-free planes with no serious complications. The mean operative time was 68 min（range 55-180 min）, the estimated blood loss was 19 ml（range 0-120 ml）, and the mean hospital stay was 4 days（range 3-7 days）. The follow-up periods of all of the 57 patients were 6-30 months（average 11 months）, all patients survived free of tumor. ConclusionInter-prerenal-fascia planes are important anatomical level of IpLRN surgery. Along the anterior fascia plane can avoid anatomical loss making sure the clear anatomy surgery field in the laparoscopic radical nephrectomy, which is conformed broadly to the principles of oncology surgery.