中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2010年
5期
296-299
,共4页
周利群%宋刚%姚鲲%何志嵩%李宁忱%宋毅%王刚%席志军%吴士良%张晓春%金杰%郝金瑞%潘柏年%郭应禄
週利群%宋剛%姚鯤%何誌嵩%李寧忱%宋毅%王剛%席誌軍%吳士良%張曉春%金傑%郝金瑞%潘柏年%郭應祿
주리군%송강%요곤%하지숭%리저침%송의%왕강%석지군%오사량%장효춘%금걸%학금서%반백년%곽응록
肾切除术%解剖学%腹腔镜%腹膜后间隙
腎切除術%解剖學%腹腔鏡%腹膜後間隙
신절제술%해부학%복강경%복막후간극
Nephrectomy%Anatomy%Laparoscopes%Retroperitoneal space
目的 探讨后腹腔镜下解剖性肾切除术的安全性和有效性,规范后腹腔镜下肾切除术术式. 方法回顾性分析后腹腔镜下解剖性肾切除术405例患者资料.男232例,女173例.平均年龄(57.2±14.2)岁.肾癌行后腹腔镜下根治性肾切除术228例,肾盂癌及输尿管癌分别行后腹腔镜下肾输尿管全长切除术96例及49例,肾脏良性疾病致肾功能丧失行后腹腔镜下肾切除术32例.根治性切除在Gerota筋膜外进行,切除界限背侧为Gerota筋膜与侧椎筋膜问、腹侧为Gerota筋膜与肾前融合筋膜间的潜在间隙;良性肾切除则直接切开Gerota筋膜,于Gerota筋膜与肾周脂肪囊问的疏松纤维组织间进行游离.在肾脏外周数个相对无血管平面间进行分离、切割,完整切除肾脏、肾周脂肪囊. 结果后腹腔镜下根治性肾切除术和单纯肾切除术平均手术时间(132±48)min,肾盂癌和输尿管癌平均手术时间(245±62)min.失血量中位值100(10～2500)ml,术后引流量中位值150(0～1152)ml.输血15例(3.70%),输血量中位值400(400～1650)ml.中转开放4例(0.99%),黏连严重2例,肾蒂暴露困难及出血各1例.平均拔管时间(3.9±1.8)d,术后平均进食时间(2.7±1.2)d,术后平均住院日(8.6±3.8)d. 结论后腹腔镜下解剖性肾切除术利用后腹腔镜下的放大优势,在肾脏周围的数个相对无血管平面进行游离,解剖层次清楚,符合外科原则,手术时间短,出血量较少,术后引流量较少,是后腹腔镜下肾切除的首选术式和发展方向.
目的 探討後腹腔鏡下解剖性腎切除術的安全性和有效性,規範後腹腔鏡下腎切除術術式. 方法迴顧性分析後腹腔鏡下解剖性腎切除術405例患者資料.男232例,女173例.平均年齡(57.2±14.2)歲.腎癌行後腹腔鏡下根治性腎切除術228例,腎盂癌及輸尿管癌分彆行後腹腔鏡下腎輸尿管全長切除術96例及49例,腎髒良性疾病緻腎功能喪失行後腹腔鏡下腎切除術32例.根治性切除在Gerota觔膜外進行,切除界限揹側為Gerota觔膜與側椎觔膜問、腹側為Gerota觔膜與腎前融閤觔膜間的潛在間隙;良性腎切除則直接切開Gerota觔膜,于Gerota觔膜與腎週脂肪囊問的疏鬆纖維組織間進行遊離.在腎髒外週數箇相對無血管平麵間進行分離、切割,完整切除腎髒、腎週脂肪囊. 結果後腹腔鏡下根治性腎切除術和單純腎切除術平均手術時間(132±48)min,腎盂癌和輸尿管癌平均手術時間(245±62)min.失血量中位值100(10～2500)ml,術後引流量中位值150(0～1152)ml.輸血15例(3.70%),輸血量中位值400(400～1650)ml.中轉開放4例(0.99%),黏連嚴重2例,腎蒂暴露睏難及齣血各1例.平均拔管時間(3.9±1.8)d,術後平均進食時間(2.7±1.2)d,術後平均住院日(8.6±3.8)d. 結論後腹腔鏡下解剖性腎切除術利用後腹腔鏡下的放大優勢,在腎髒週圍的數箇相對無血管平麵進行遊離,解剖層次清楚,符閤外科原則,手術時間短,齣血量較少,術後引流量較少,是後腹腔鏡下腎切除的首選術式和髮展方嚮.
목적 탐토후복강경하해부성신절제술적안전성화유효성,규범후복강경하신절제술술식. 방법회고성분석후복강경하해부성신절제술405례환자자료.남232례,녀173례.평균년령(57.2±14.2)세.신암행후복강경하근치성신절제술228례,신우암급수뇨관암분별행후복강경하신수뇨관전장절제술96례급49례,신장량성질병치신공능상실행후복강경하신절제술32례.근치성절제재Gerota근막외진행,절제계한배측위Gerota근막여측추근막문、복측위Gerota근막여신전융합근막간적잠재간극;량성신절제칙직접절개Gerota근막,우Gerota근막여신주지방낭문적소송섬유조직간진행유리.재신장외주수개상대무혈관평면간진행분리、절할,완정절제신장、신주지방낭. 결과후복강경하근치성신절제술화단순신절제술평균수술시간(132±48)min,신우암화수뇨관암평균수술시간(245±62)min.실혈량중위치100(10～2500)ml,술후인류량중위치150(0～1152)ml.수혈15례(3.70%),수혈량중위치400(400～1650)ml.중전개방4례(0.99%),점련엄중2례,신체폭로곤난급출혈각1례.평균발관시간(3.9±1.8)d,술후평균진식시간(2.7±1.2)d,술후평균주원일(8.6±3.8)d. 결론후복강경하해부성신절제술이용후복강경하적방대우세,재신장주위적수개상대무혈관평면진행유리,해부층차청초,부합외과원칙,수술시간단,출혈량교소,술후인류량교소,시후복강경하신절제적수선술식화발전방향.
Objective To evaluate the safety and efficacy of the anatomical retroperitoneoscopic nephrectomy(RSN)and standardize the procedure of RSN. Methods The retrospective analysis was performed on 405 consecutive patients underwent anatomical RSN in Our institute from January 2002 to June 2008.There were 232 male and 173 female patients with the average age of(57.2±14.2)years,among whom there were 228 renal cell carcinoma patients accepted RSU,96 and 49 renal pelvic carcinoma and ureteral carcinoma cases accepted retroperitoneoscopic ureteronephrectomy (RSUN) and 32 cases accepted simple RSN due to loss of renal function caused by benign renal discsses.The tadical RSN was performed by dissecting outside Gerota's fascia and in the latent cavities between this fascia and lateral conal fascia in the dorsal side and between this fascia and prerenal fusion fascia in the ventral side,whereas the simple RSN was done inside Gerota's fascia by making direct incision on it and dissecting between this fascia and perirenal adipose tissue.Kidneys and perirenal adipose tissue were completely removed by dissection along several avascular planes around the kidney under the amplified view of laparoscopy. The software SPSS 12.0 was used for the statistical analysis of all data. Results The mean operative time was (132±48)min for radical and simple RSN and (245 ± 62)min for radical RSUN, which included the time for position change and second skin preparation. The medium estimated blood loss was 100 ml(10-2500 ml) and the average drainage volume was 150 ml (0-1152 ml) postoperatively. 15 cases (3. 70%) required blood transfusion with the median volume of 400ml (400-1650 ml). Four cases (0. 99%) were converted to open surgery due to severe adhesion (2 cases), difficult exposure of renal helium (1 case) and severe bleeding (1 case).The mean drainage time was (3. 9±1.8)d, the mean time to first oral intake was (2.7±1.2)d and the mean postoperative hospital stay was (8.6±3. 8)d. Conclusion The anatomical RSN is safe and effective and should be the standard surgical procedure for laparoscopic nephrectomy.
