摘要
目的 总结经腹腹腔镜肾癌根治性切除术的经验及评价临床价值。方法 肾癌 32例 ,肿瘤平均直径 4 6cm ,左侧 17例 ,右侧 15例 ,2 6例肿瘤直径小于 8 0cm ,采用经腹腹腔镜肾癌根治术。 6例肿瘤直径大于 8 0cm ,采用手辅式腹腔镜肾癌根治术。结果 31例腹腔镜肾癌根治手术成功 ,1例右肾动脉损伤改开放手术 ,1例胰腺损伤 ,1个月后治愈 ;手术时间 90～ 36 0min ,平均 178min。术中出血约 70～ 4 2 0ml,平均 130ml。 2例穿刺口周围不同程度皮下气肿 ,3d后自行消失。术后 2 4h下床活动 ,4 8h开始进食 ,术后 7d出院。 2 1例随访 0 5～ 4年 ,无肿瘤复发 ,无穿刺孔种植转移。结论 腹腔镜肾癌根治术具有术中创伤小 ,术后恢复快 ,疼痛小的优点 ,对于T1～T2 N0 M0 期肾肿瘤 ,效果优于开放手术 ;是一种安全、有效的治疗方法。
Objective To evaluate the clinical value of transabdominal laparoscopic radical nephrectomy in the treatment of patients with renal carcinoma. Methods 32 cases of renal carcinoma were studied. 17 cases had left-sided diseases and 15 had right. 26 cases who had tumors less than 8 cm in diameter were treated by transabdominal laparoscopic radical nephrectomy. 6 cases who had tumors more than 8 cm in diameter were treated by hand-assisted transperitoneoscopic radical nephrectomy. Results In 31 of 32 cases, nephrectomies were performed successfully by laparoscopic procedure. In 1 case, the procedure needed conversion to open surgery because of uncontrollable bleeding from injury to the right renal artery. In 1 case,injury of pancreas occurred, which was cured after one month. Operative time ranged from 90～360 min (mean operative time 178 min). Intraoperative blood losses were 70～420 ml(mean blood loss 130 ml). Subcutaneous emphysema around the ports sites in 2 cases spontaneously disappeared 3 days post operation. The patients resumed activity 24 hours, began oral intake 48 hours and were discharged 7 days post operation. No local lesion and port sites metastasis occurred in 21 cases of these patients in 0.5～4 years follow-up.Conclusion As compared to open radical nephrectomy, laparoscopic radical nephrectomy has the advantages of rapid recovery and less pain. Laparoscopic radical nephrectomy needs a higher skill, but it was superior to open nephrectomy for renal tumor of T 1～T 2bN 0M 0. It was a safe, effective and efficient surgical procedure.
出处
《广东医学》
CAS
CSCD
北大核心
2005年第1期10-12,共3页
Guangdong Medical Journal
