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肾脏肿瘤是泌尿外科占第二位的肿瘤,其中绝大部分是恶性的,主要治疗方法是根治切除术。目前, 随着腹腔镜技术的迅猛发展, 腹腔镜肾癌根治术已广泛应用于临床。多数泌尿外科医生习惯经腹膜后腔入路[1],该途径虽然显露肾蒂较容易,但操作空间狭小, 对于右侧病变,术中处理右肾静脉较左侧要复杂,一旦处理不当,极易造成右肾静脉和/或下腔静脉的损伤,严重者可引起大出血,甚至危及生命。我科对右肾肿瘤病人行后腹腔镜下肿瘤根治术时, 在处理右肾静脉将常用方法作了改进,现作报道。
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35例手术均在后腹腔镜下顺利完成, 无中转开放手术。术中曾1例右肾静脉超宽病人,其宽度约是规格为2.5 cm×1.0 cm的Hem-lok夹的2倍(见图 3),术中在充分显露右肾静脉汇入下腔静脉两个角后,在腹腔镜下先用丝线结扎使其缩窄后用Hem-lok完全夹闭(见图 4)。
2组各出现3例主操作孔侧小切口延迟愈合,考虑为曲卡引起的皮肤、皮下组织挫伤所致,通过加强换药而恢复,术后4周复查血常规、血生化常规皆无明显异常。A组手术时间、术中出血量及术后拔管时间均少于B组(P < 0.01)(见表 1)。
分组 n 手术时间/min 术中出血量/mL 术后卧床时间/d 术后拔管时间/d 术后住院时间/d A组 16 76.6± 22.5 72.8±9.2 2.6±0.5 2.2±0.6 7.2±0.7 B组 19 116.3±34.6 138.1±8.4 2.2±0.7 5.6±0.8 7.6±0.9 t — 3.94 21.94 1.91 13.99 1.97 P — < 0.01 < 0.01 >0.05 < 0.01 >0.05 表 1 2组各项观察指标比较(x±s)
后腹腔镜下右肾癌根治术中肾静脉处理方法比较
Comparison of renal vein management in retroperitoneoscope radical resection of right renal carcinoma
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摘要:
目的探讨后腹腔镜下右肾癌根治术中不同肾静脉处理方法对手术的影响。 方法后腹腔镜下右肾癌根治术35例中,肾唇附近离断肾动脉(A组)16例,下腔静脉右侧壁旁离断肾动脉(B组)19例,比较2组手术时间、术中出血量、放置引流管时间、术后卧床时间及术后住院时间的差异。 结果A组在手术时间、术中出血量、放置引流管时间方面均优于B组(P < 0.01)。术后卧床时间及术后住院时间2组差异均无统计学意义(P>0.05)。 结论后腹腔镜下右肾癌根治术中,肾唇附近离断右肾动脉,相比下腔静脉右侧壁旁离断右肾动脉手术操作便利,节省手术时间,减少手术创伤,提高手术安全性,此种方法值得借鉴。 Abstract:ObjectiveTo investigate the effect of different renal vein management methods on right renal carcinoma radical operation under retroperitoneoscope. MethodsRetrospective analysis of the clinical data of 35 patients with right renal cancer who underwent retroperitoneal laparoscopic radical resection of right renal carcinoma:the renal artery was severed near the lip of the kidney(group A) and the renal artery was severed near the right lateral wall of the inferior vena cava (group B). ResultsThe operative time of group A was better than that of group B in terms of intraoperative blood loss and drainage tube placement time, with statistically significant differences(P < 0.01).There was no statistically significant difference in postoperative bed time and postoperative hospital stay between the two groups(P>0.05). ConclusionsIn the radical surgery of right renal carcinoma under retroperitoneal laparoscope, the separation of the right renal artery near the lip of the kidney is more convenient than that near the right wall of the inferior vena cava, which saves the operation time, reduces the surgical trauma and improves the surgical safety.This method is worthy of reference. -
表 1 2组各项观察指标比较(x±s)
分组 n 手术时间/min 术中出血量/mL 术后卧床时间/d 术后拔管时间/d 术后住院时间/d A组 16 76.6± 22.5 72.8±9.2 2.6±0.5 2.2±0.6 7.2±0.7 B组 19 116.3±34.6 138.1±8.4 2.2±0.7 5.6±0.8 7.6±0.9 t — 3.94 21.94 1.91 13.99 1.97 P — < 0.01 < 0.01 >0.05 < 0.01 >0.05 -
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