中国实用医刊
中國實用醫刊
중국실용의간
CENTRAL PLAINS MEDICAL JOURNAL
2014年
14期
38-40
,共3页
根治性肾切除%腹膜后腹腔镜%解剖
根治性腎切除%腹膜後腹腔鏡%解剖
근치성신절제%복막후복강경%해부
Radical nephrectomy%Retroperitoneal laparoscopy%Anatomy
目的：介绍后腹腔镜下解剖性根治性肾切除术的手术方法及临床效果。方法对187例肾癌患者实施后腹腔镜下解剖性根治性肾切除术。其中左侧103例，右侧84例；肿瘤最大径2.0~8.2 cm，平均4.6 cm；所有患者均常规制备后腹腔间隙，按顺序分别进入相对无血管解剖层面进行分离，腰大肌为背侧标志，膈肌为肾上极后侧标志，肾上腺为肾上方内侧标志，腹膜为腹侧标志，下腔静脉与腹主动脉是内侧的标志，髂血管是 Gerota 筋膜锥尖部的解剖标志。结果所有手术均获成功，无中转开放手术，术中无明显并发症发生。手术时间90~150 min，平均110 min；出血60~100 ml，平均75 ml；恢复饮食和下床活动时间分别为 l.3 d 和1.2 d；术后3~7 d 出院。142例患者术后随访6~42个月，其中1例出现腹膜后淋巴结转移，余经 B 超及胸片检查未见局部复发或远处转移。结论后腹腔镜下解剖性根治性肾切除术具有解剖层次清楚，术中出血少，术野清晰，疗效确切，并发症少，恢复快等优点，为需要根治性肾切除术的患者提供了更好的选择。
目的：介紹後腹腔鏡下解剖性根治性腎切除術的手術方法及臨床效果。方法對187例腎癌患者實施後腹腔鏡下解剖性根治性腎切除術。其中左側103例，右側84例；腫瘤最大徑2.0~8.2 cm，平均4.6 cm；所有患者均常規製備後腹腔間隙，按順序分彆進入相對無血管解剖層麵進行分離，腰大肌為揹側標誌，膈肌為腎上極後側標誌，腎上腺為腎上方內側標誌，腹膜為腹側標誌，下腔靜脈與腹主動脈是內側的標誌，髂血管是 Gerota 觔膜錐尖部的解剖標誌。結果所有手術均穫成功，無中轉開放手術，術中無明顯併髮癥髮生。手術時間90~150 min，平均110 min；齣血60~100 ml，平均75 ml；恢複飲食和下床活動時間分彆為 l.3 d 和1.2 d；術後3~7 d 齣院。142例患者術後隨訪6~42箇月，其中1例齣現腹膜後淋巴結轉移，餘經 B 超及胸片檢查未見跼部複髮或遠處轉移。結論後腹腔鏡下解剖性根治性腎切除術具有解剖層次清楚，術中齣血少，術野清晰，療效確切，併髮癥少，恢複快等優點，為需要根治性腎切除術的患者提供瞭更好的選擇。
목적：개소후복강경하해부성근치성신절제술적수술방법급림상효과。방법대187례신암환자실시후복강경하해부성근치성신절제술。기중좌측103례，우측84례；종류최대경2.0~8.2 cm，평균4.6 cm；소유환자균상규제비후복강간극，안순서분별진입상대무혈관해부층면진행분리，요대기위배측표지，격기위신상겁후측표지，신상선위신상방내측표지，복막위복측표지，하강정맥여복주동맥시내측적표지，가혈관시 Gerota 근막추첨부적해부표지。결과소유수술균획성공，무중전개방수술，술중무명현병발증발생。수술시간90~150 min，평균110 min；출혈60~100 ml，평균75 ml；회복음식화하상활동시간분별위 l.3 d 화1.2 d；술후3~7 d 출원。142례환자술후수방6~42개월，기중1례출현복막후림파결전이，여경 B 초급흉편검사미견국부복발혹원처전이。결론후복강경하해부성근치성신절제술구유해부층차청초，술중출혈소，술야청석，료효학절，병발증소，회복쾌등우점，위수요근치성신절제술적환자제공료경호적선택。
Objective To introduce the technique and clinical effect of anatomical retroperitone-al laparoscopy radical nephrectomy. Methods A total of 187 patients underwent anatomical retroperito-neal laparoscopy radical nephrectomy. Among them,103 cases of tumor located in the left kidney and 84 cases located in the right kidney. The maximum diameter of tumor was 2. 0 to 8. 2 cm,with an average di-ameter of 4. 6 cm. Retroperitoneal space was created routinely at lateral decubitus position. Relatively bloodless planes were orderly entered for exposure and separation of the kidney outside Gerota’s fascia. In the first place,the greater psoas was identified as the dorsal marker. Then the diaphragmatic muscle was identified as the posterior mark of the upper pole of the kidney,and the adrenal gland as the medial marker of the upper pole of the kidney,and the peritoneum as the ventral maker,and the inferior vena cava and abdominal aorta was the medial marker. Iliac blood vessels was the mark of Gerota’s fascia cone tip. Results All operations were successful,with no case transferred to open operation. No case had blood transfusion and severe complications during surgery. The mean operative time was 110 min (range from 90 to 150 min). The mean intraoperative blood loss was 75 ml(range from 60 to 100 ml). Average days to oral intake and ambulation were 1. 3 and 1. 2 days. All patients discharged from hospital on 3 to 7 days after surgery. One hundred and forty-two patients were followed-up for 6 to 42 months. Only one case suffered from retroperitoneal lymph mode metastasis. Others had no local recurrence or dis-tant metastasis by ultrasound and chest X ray inspection. Conclusions Anatomical retroperitoneal lapa-roscopy radical nephrectomy is a safe and effective procedure. It can decrease operation time,blood loss and complication rates effectively,and provide a better choice for the patient whom demand radical ne-phrectomy.
