后腹腔镜肾切除术肾蒂血管处理技巧

Operative skills of renal pedicle vessels in retroperitoneal laparoscopic nephrectomy

目的:探讨后腹腔镜肾切除术肾蒂血管的处理技巧。方法:2010年1月至2018年4月由同一术者为329例患者行腹膜后入路腹腔镜肾切除术,根据肾蒂血管处理方式分为非同步组(n=175)与同步组(n=154),均采用3孔法施术,经腹膜后入路,显露肾蒂,非同步组采用先处理肾动脉的方法,游离肾脏,最后结扎肾静脉。同步组先游离出肾动脉及肾静脉并结扎,最后游离肾脏。巨大肾积水者,先吸出部分积液,以利显露肾蒂。对比分析两组手术时间、术中失血量。结果:两组手术均顺利完成。非同步组与同步组手术时间分别为(101.7±36.9)min与(121.9±39.1)min,术中失血量分别为(83.3±63.9)mL与(115.3±43.2)mL,两组手术时间、术中出血量差异有统计学意义(P<0.05)。结论:后腹腔镜肾切除术的关键是肾蒂血管的处理,术中灵活选择手术步骤、非同步处理肾脏动静脉有助于减少术中出血,缩短手术时间,增加手术安全性。

Objective:To explore the operative skills of renal pedicle vessels in retroperitoneal laparoscopic nephrectomy. Methods:From Jan.2010 to Apr.2018,329 patients underwent retroperitoneal laparoscopic nephrectomy.According to the treatment of renal pedicle vessels,they were divided into asynchronous group ( n = 175) and synchronous group ( n = 154).All patients underwent three-port operation.The renal pedicle was exposed through retroperitoneal approach.In the asynchronous group,the renal artery was first treated,the kidney was free,and the renal vein was finally ligated.In the synchronous group,the renal artery and vein were separated and ligated,and the kidney was finally free.In the case of giant hydronephrosis,part of the hydronephrosis was sucked out to expose the renal pedicle.The operation time or blood loss were compared between the two groups.Results:The operation was successfully completed in both groups.The operation time of asynchronous group and synchronous group were ( 101.7±36.9) min and ( 121.9±39.1) min respectively. The intraoperative blood loss was ( 83.3±63.9) mL and ( 115.3±43.2) mL,respectively.There were significant differences in operation time or bleeding volume between the two groups ( P<0.05).Conclusions:The key of retroperitoneal laparoscopic nephrectomy is the management of renal pedicle vessels.Flexible selection of surgical procedures and asynchronous treatment of renal arteries and veins during operation can help to reduce intraoperative bleeding,shorten operation time and increase operation safety.