摘要
目的探讨后腹腔镜下根治性肾切除术中寻找、处理肾蒂的技巧。
方法回顾性分析2011年4月至2015年4月收治的224例行后腹腔下根治性肾切除术的肾肿瘤患者的临床资料。126例采用沿输尿管上行法寻找肾蒂（研究组），男77例，女49例。年龄42～84岁，平均（56.6±9.0）岁。肿瘤位于左侧67例，右侧59例。肿瘤平均直径（5.3±1.1）cm。TNM分期：T1aN0M0期25例，T1bN0M0期75例，T1bN1M0期3例，T2N0M0期23例。术中首先在髂嵴处找到输尿管，此处输尿管离腰大肌最近，最易找到。然后沿输尿管上行，直到肾盂处，肾盂上沿即为肾蒂。98例采用肾中部隆起法寻找肾蒂（对照组），男64例，女34例。年龄27～81岁，平均（57.9±8.3）岁。肿瘤左侧52例，右侧46例。肿瘤直径3.3～9.7cm，平均（5.5±1.4）cm。TNM分期：T1aN0M0期19例，T1bN0M0期61例，T1bN1M0期2例，T2N0M0期16例。比较两组寻找肾蒂时间、手术时间、出血量、围手术期并发症和术后住院时间等。
结果研究组和对照组寻找肾蒂时间分别为（2.2±1.1）min和（4.5±2.0）min，手术时间分别为（73.7±67.3）min和（90.1±87.5）min，术中出血量分别为（69.8±42.7）ml和（89.7±89.2）ml，并发症发生例数分别为3例和9例，组间比较差异均有统计学意义（P〈0.05）；术后住院时间分别为（7.5±0.8）d和（7.3±0.8）d，排气时间分别为（2.1±0.6）d和（2.2±0.6）d，组间比较差异均无统计学意义（P〉0.05）。研究组3例并发症均为腔静脉肾静脉撕裂，其中1例缝合裂口，2例应用钛夹止血成功。对照组9例并发症中，腔静脉撕裂3例，中转开放手术止血2例，应用钛夹止血1例；左侧腰静脉破裂3例，经缝合、钛夹、双极电凝止血成功；腹膜后血肿2例，采用保守治疗后治愈；轻度肺栓塞1例，行溶栓治疗后好转。
结论后腹腔镜下根治性肾切除术中采用沿输尿管上行法可迅速、准确定位肾蒂，缩短了手术时间，减少了并发症的发生。
Objective To explore the operating skills of finding and dissecting renal pedicle in retroperitoneosocpie radical nephrectomy. Methods From April 2011 to April 2015,224 patients with renal tumors were treated by retroperitoneosocpic radical nephrectomy. Along the ureteral ascending methodis used to find renal pedicle for 126 cases（ the research group） ：First found ureter in the iliac crest, the ureter was nearest psoas major here and waseasy to find. Along the ureteral upward until to the renal pelvis and the superior border of renal pelvis is the renal pedicle. 77 male and 49 female cases, Age 42 to 84 years, （ 56. 6 ± 9. 0 ） years old on average. Sixty-nine tumors were located in left kidney, and 59 in the right kidney. The mean diameter of renal tumor was（5.3±1.1 ）cm. There were 25 cases of TlaNoM0 ,75 TlbNoM0 ,23 of T2NoMo ,3 of TlbN1M0. Over the same period uplift in he kidney central method is used to find renal pedicle for 98 cases. 64 male and 34 female eases, Age 27 to 81 years, （57.9± 8.3 ）years old on average. 52 tumors were located in left kidney, and 46 in the right kidney. The mean diameter of renal tumor was （ 5.5 ±1.4）cm. There were 19 cases of TlaNoMo,61 TlbNoM0,16 of T2NoM0,2 of TlbNIM0. Results The differences were significant for Looking for renal pedicle time（2. 2 ± 1.1 vs. 4. 5 ±2. 0） min,operation time （73.7 ±67.3 vs. 90. 1±87.5）min, hemorrhage volume（69. 8 ±42.7 vs. 89. 7 ±89. 2） ml, the incidence of complications （ 3 vs. 9） between the study group and the control group （ P 〈 0. 05 ）. The difference were not significant in postoperative hospital stay （ 7.5 ± 0. 8 vs. 7. 3 ±0. 8 ） d, exhaust time （ 2. 1 ± 0. 6 vs. 2. 2 ± 0. 6 ） d between two group. All the operations were performed successfully in the research group, with no conversion to open and transfusion. Major complications included 3 cases of vessel injury. Hemostasis was performed with metal clips and suture. In the control group,ena cava rupture in 3 cases, left lumbar veins rupture in 3 cases, retroperitoneal hematoma in 2 case, mild pulmonary embolism in 1 case. two case performed open operation owing to vena cava rupture. The vena cava rupture transit open surgery in 2 cases, and Hemostasis was performed with metal clips in 1 case of vena cava rupture and on the left side of the lumbar veins rupture was managed by suture, titanium clips and bipolar electrocautery; Retroperitoneal hematoma improved by conservative treatment;Pulmonary embolism improved by medical consultation after thrombolysis. Conclusions Retroperitoneosocpic radical nephrectomy with the method of along the ureteral ascending was safe and could quickly locate and ligate the renal pedicle, and shorten operation time, reduce postoperative complications.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2016年第7期529-532,共4页
Chinese Journal of Urology
基金
河南省科学技术厅基础与前沿技术研究项目（152300410157）
