CAJ | 학술논문

目的探讨经腹腔入路腹腔镜下根治性肾切除(LRN)的手术操作技巧. 方法对2008年12月至2010年12月收治的105例肾肿瘤患者采用经腹腔入路行LRN.肿瘤位于左肾51例,右肾54例,直径(5.8 ±2.4)cm.术前肿瘤分期为T1N0M048例,T2N0M0 51例,T3aN0M06例.术中均以生殖静脉为标志寻找肾动、静脉并依次结扎,完整切除标本后经耻骨上Pfannensteil切口取出. 结果 105例均成功施行经腹腔“生殖静脉标志法”LRN,28例肾上极肿瘤切除同侧肾上腺,16例加行区域淋巴结清扫.无中转开放手术者,无肝、脾、肠管等重要脏器损伤.手术时间44～78 min,平均(55±11)min.术中出血量35～600 ml,平均(85±26)ml.术后住院时间4～11 d,平均(6±2)d.主要并发症有血管损伤3例,膈肌损伤1例,淋巴漏2例.术后临床病理分期为T1N0M044例,T1N1M01例,T2 N0 M0 47例,T2N1M0 1例,T3aN0M0 7例,T3aN1M0 1例,T4N0M0 2例,良性病变2例.术后随访9～33个月,平均18个月,出现切口疝1例,局部复发1例,死于肺转移1例. 结论经腹途径“生殖静脉标志法”LRN可准确定位、迅速结扎肾蒂大血管,术中无严重副损伤,术后恢复快、并发症少.Pfannensteil切口创伤小,符合美学要求.
목적 탐토경복강입로복강경하근치성신절제(LRN)적수술조작기교. 방법 대2008년12월지2010년12월수치적105례신종류환자채용경복강입로행LRN.종류위우좌신51례,우신54례,직경(5.8 ±2.4)cm.술전종류분기위T1N0M048례,T2N0M0 51례,T3aN0M06례.술중균이생식정맥위표지심조신동、정맥병의차결찰,완정절제표본후경치골상Pfannensteil절구취출. 결과 105례균성공시행경복강“생식정맥표지법”LRN,28례신상겁종류절제동측신상선,16례가행구역림파결청소.무중전개방수술자,무간、비、장관등중요장기손상.수술시간44～78 min,평균(55±11)min.술중출혈량35～600 ml,평균(85±26)ml.술후주원시간4～11 d,평균(6±2)d.주요병발증유혈관손상3례,격기손상1례,림파루2례.술후림상병리분기위T1N0M044례,T1N1M01례,T2 N0 M0 47례,T2N1M0 1례,T3aN0M0 7례,T3aN1M0 1례,T4N0M0 2례,량성병변2례.술후수방9～33개월,평균18개월,출현절구산1례,국부복발1례,사우폐전이1례. 결론 경복도경“생식정맥표지법”LRN가준학정위、신속결찰신체대혈관,술중무엄중부손상,술후회복쾌、병발증소.Pfannensteil절구창상소,부합미학요구.
Objective To discuss the operating skills of transperitoneal laparoscopic radical nephrectomy(LRN).Methods From Dec 2008 to Dec 2010,105 patients with renal tumors were treated by transperitoneal LRN.Fifty-one tumors were located in left kidney,and 54 in the right kidney.The mean diameter of renal tumor was(5.8 ± 2.4)cm.There were 48 cases of T1N0M0,51 of T2N0M0,6 of T3aN0M0.During the process of transperitoneal LRN,vena genitalis was constantly used as an operative mark for seeking and ligating the renal artery and vein.The specimens were cut completely and removed through Pfannensteil incision.Results All the 105 cases were performed by transperitoneal LRN with vena genitalis marking method successfully.Twenty-eight cases of homolateral adrenal gland were resected and 16 cases of regional lymph node were cleaned.There was no serious injury of liver,spleen or bowels.The operating time ranged 44-78 min with an average of 55 min,and the blood loss was 35-600 ml with the mean of 85 ml.The post-operative length of stay was 4-11 d with an average of 6 d.Major complications included 3 cases of vessel injury,1 case with an injury of diaphragmatic muscle and 2 cases with a lymphous leakage.Post-operative staging included 44 cases of T1 N0 M0,1 of T1 N1 M0,47 of T2 N0 M0,1 of T2 N1 M0,7of T3aN0M0,1 of T3aN1 M0,2 of T4N0M0,and 2 cases with benign lesion.The patients were followed up for 9-33 months with an average of 18 months.One case had an incisional hernia,1 had a local tumor recurrence and 1 died of pulmonary metastasis.Conclusions Transperitoneal LRN with vena genitalis marking method could be safe for the treatment of renal tumors.The vena genitalis may act as a mark for the accurate location and quick ligation for the renal pedicle without serious injuries,and such patients could recover fastly with fewer complications.Pfannensteil incision has a good quality of little trauma and could meet with the need of aesthetics.