经腹腔途径腹腔镜肾切除术中程序化背下方入路肾蒂血管显露及处理技术的临床应用

Exposure and treatment technique of renal pedicle vessels through programmed inferoposterior access during transperitoneal laparoscopic nephrectomy

目的探讨经腹腔途径腹腔镜肾切除术中程序化背下方入路肾蒂血管显露和处理技术的临床应用效果。方法回顾性分析2014年6月~2020年12月在我院采用背下方入路技术手术患者的临床资料,包括经腹腔根治性肾切除术(TLRN)116例和经腹腔根治性肾输尿管切除术(TLRNU)23例,共139例。所有患者采用背下方入路技术显露和处理肾蒂血管,均按游离结肠、显露肾门、夹闭肾血管三个步骤程序化进行。记录相关临床数据,包括年龄、体质指数、肿瘤大小、肾切除手术时间、肾血管处理时间、术中出血量以及手术并发症。结果手术均顺利完成,平均肾切除手术时间为(121.90±19.71)min,平均肾血管处理时间为(51.32±5.74)min,平均术中出血量为(51.70±25.11)ml。无一例发生肾血管并发症。结论在TLRN和TLRNU术中,程序化背下方入路显露和处理肾蒂血管技术有助于简化手术流程,安全可行,值得临床推广应用。

Objective To explore the clinical application effect of exposure and treatment technique of renal pedicle vessels through programmed inferoposterior access during transperitoneal laparoscopic nephrectomy.Methods Retrospectively reviewed the clinical date of 139 cases of transperitoneal laparoscopic radical nephrectomy(TLRN)and transperitoneal laparoscopic radical nephroureterectomy(TLRNU)from Jun 2014 to Dec 2020 in our hospital.Inferoposterior access technique was adopted to expose and treat renal pedicle vessels.All operation procedures were performed by programmed three steps:colon separation,renal hilar exposure and renal vessls clipping.Relevant clinical data were recorded including age,body mass index,tumor sizes,surgical time of nephrectomy,renal vessels treatment time,introoperation blood loss,and surgical complications.Results All operations were successfully performed.Mean operative time of nephrectomy was(121.90±19.71)min,mean renal pedicle vessels treatment time was(51.32±5.74)min,mean introoperative blood loss was(51.70±25.11)ml.There were no complications involving renal vessels.Conclusion Exposure and treatment technique for renal pediclc vessels through programmed inferoposterior acces during TLRN and TLRNU may help to simplify the operating procedure,it is safe and feasible,and is worthy of clinical application and promotion.