双侧腹膜后途径治疗左肾癌伴0b级静脉癌栓手术运用体会

Surgicalexperience of bilateral retroperitoneal approach for left renal cell carcinoma with grade 0b ve-nous tumor thrombus

目的探讨腹腔镜下双侧腹膜后途径治疗左肾细胞癌伴0b级(301分级,癌栓超过肠系膜上动脉、未进入下腔静脉)静脉癌栓手术方式的技术要点及临床价值,并对其进行初步经验总结。方法回顾性分析2016年1月至2022年4月收治的14例左侧肾细胞癌伴0b级静脉癌栓患者的临床资料。术前行MRI、CT检查明确癌栓的位置,均为左肾静脉0b级癌栓。所有患者均经双侧腹膜后途径行腹腔镜肾癌根治术及癌栓剥除术治疗。结果所有手术均成功,无中转开放,手术时间(155.15±21.01)min,术中出血量(115.71±74.26)ml,术后住院天数中位数为5.50(IQR:5.00,6.25)d,术后引流管拔除时间中位数为3.00(IQR:3.00,4.00)d,术后平均排气时间中位数为1.50(IQR:1.00,2.00)d,术后视觉模拟评分中位数为3.00(IQR:2.75,4.00)分。结论双侧腹膜后途径的手术方式在完成治疗目的的同时,降低手术出血风险及并发症,达到快速康复的目的,是有效的处理方式。

Objective To analyze the superiority of laparoscopic bilateral retroperitoneal approach in treatment of left renal cell carcinoma with grade 0b venous thrombus(grade 301,the tumor thrombus exceed the superior mesenteric artery but not enter the inferior vena cava).Methods From January 2016 to April 2022,clinical data of 14 patients who suffered from left renal cell carcinoma with grade 0b venous thrombus and were admitted to hospital were analyzed retrospectively.Magnetic resonance imaging and computerized tomography were performed before surgeries to locate the tumor thrombus.All patients consented to accept laparoscopic radical nephrectomy and tumor embolectomy by bilateral retroperitoneal approach.Results All surgeries were successful without transferring opening.The surgery time was(155.15±21.01)minutes,and the intraoperative blood loss was(115.71±74.26)milliliters.The median postoperative hospital stay was 5.50(IQR:5.00,6.25)days,and the median postoperative drainage tube removal time was 3.00(IQR:3.00,4.00)days.The median postoperative exhaust time was 1.50(IQR:1.00,2.00)days;and the median of visual analogue scale was 3.00(IQR:2.75,4.00)points.Conclusions Bilateral retroperitoneal approach is an effective treatment method,which can reduce the intraoperative hemorrhage and complications to achieve rapid recovery.