后腹腔镜根治性肾切除术的临床应用

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1、中华腔镜外科杂志(电子版)2009年12月第2卷第1期ChinJLaparoscopicSurgery(ElectronicEdition)，December2009，Vol2，NO．1·32临床研究●后腹腔镜根治性肾切除术的临床应用赵杰【摘要】目的探讨后腹腔镜根治性肾切除术的可行性、安全性及临床疗效。方法2003年3月至2008年2月行后腹腔镜根治性肾切除术52例。男29例，女23例。年龄24～78岁，平均年龄57岁。右侧27例，左侧25例。无痛性全程肉眼m尿8例，其余44例为超声体检发现。肿瘤的大小1．5cmx1．8cm～8．7cmx9．2cm，平均3．6cmx4．3cm

2、。肿瘤位于肾上极l9例，肾中部l5例，肾下极18例。52例均行CT检查，l9例行MRI检查。术前临床分期：TlN0M05例，T2N0M045例，T3aN0M02例。结果52例均获成功，无中转开放手术患者，有l3例腹膜破裂，有6例术后肩部隐痛，有4例切口皮下气肿，患者均在短期恢复。术后均无使用镇痛剂。手术时间90~230min，平均l52min：出血量50~200ml，平均l20ml；术后住院时间6~9d，平均7．5d。术后病理报告：肾透明细胞癌49例，囊性肾细胞癌2例，肾颗粒细胞癌1例。随访6~36个月，平均l5个月，未见肿瘤复发。结论后腹腔镜根治性。肾切除术安全可行、疗效肯

3、定。【关键词】肾肿瘤；后腹腔镜；肾切除术TheclinicalapplicationofretroperitoneallaparoscopicradicalnephrectomyZHA0．fie．ThefirstHospitalofXinxiangCity,Xinxiang453000,China[Abstract]ObjectiveToexplorethefeasibility，safetyandclinicalefectofretroperitoneallaparoscopicradicalnephrectomy．Methods52patients(29males，23f

4、emales)withmeanageof57yearsrange(24-78years)underwentretroperitoneallaparoscopicradicalnephrectomyfrommarch2003tofebruary2008．27caseslocatedintherightand25caseslocatedintheleft．8caseswerepainlesswholecoursegrosshematuria，andother44caseswerefoundbyultrasonicphysicalexamination．Thetumorsizera

5、ngedform1．5cmx1．8cmto8．7cmx9．2cmmean(3．6cmx4．3cm)19caseslocatedintheupperroleofkidney,15caseslocatedinthemiddleroleofkidney,18caseslocatedinthelowerroleofkidney．52caseswereallbyCTseanand19caseswerebyMRIscan．Preoperativeclinicalstaging：5caseswereT1NoMo．45caseswereT21oM0and2caseswereT3aNoMoRe

6、sultsSuccesshadbeenachievedinallcasesandnopatientconversionstoopensurgery．13caseshadperitoneumrupture，6caseshaddullpaininshoulderpostoperativeand4caseshadsubcutaneousemphysemainincision．Thepatientswereallrecoveryinshorttime．Postoperativetherewerenouseanalgesics．Theoperativetimerangedfrom90t

7、o230minutesmean(152minutes)bleedingvolumerangedfrom50to200mlmean(120m1)Postoperativehospitalstayrangedfrom6to9daysmeanf7．5days)Postoperativepathologicalreports：49caseswererenalclearcellcarcinoma，2caseswerecysticrenalcellcarcinoma，1casewasrenalgranularcar