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目的探讨腰腹联合三步法腹腔镜肾部分切除术临床应用的安全性和有效性。方法回顾分析2015年7月至11月期间,32例接受腹腔镜肾部分切除术患者的临床资料。其中接受腰腹联合三步法术式的患者12例(三步法组),接受传统经腹术式患者20例(对照组)。三步法组手术方法:(1)首先经腹入路,切开腹侧Gerota筋膜和肾周脂肪至肾实质表面,并显露肿瘤;(2)沿结肠旁沟Told线切开腹膜和肾周筋膜,由肾脏背侧,贴腰大肌平面分离肾动脉;(3)阻断肾动脉,标记肿瘤边缘,完成肾脏肿瘤的切除和创面重建。比较两组围手术期资料。结果 32例手术均顺利完成,腰腹联合三步法相比传统经腹腔途径可有效缩短手术时间(P=0.014),术中出血等围手术期资料与传统方法类似。结论腰腹联合三步法改良后的腹腔镜肾部分切除术既保留了经腹途径操作空间大的优点,又结合了经腰途径分离肾动脉便捷的长处,尤其肾动脉出现变异时,优势更加明显,可进行深入的临床对比研究。
Objective To investigate the safety and efficacy of laparoscopic partial nephrectomy combined with three-step laparotomy in the treatment of lumbar spine. Methods The clinical data of 32 patients undergoing partial laparoscopic partial nephrectomy from July 2015 to November 2015 were retrospectively analyzed. Among them, 12 patients (three-step method group) received three-step lumbar-abdominal surgery, and 20 patients underwent traditional transabdominal surgery (control group). Three-step operation method: (1) First of all transabdominal approach, cut open the ventral Gerota fascia and perirenal fat to the renal parenchymal surface and reveal the tumor; (2) along the colorectal glottic line Told peritoneum and kidney Week fascia, the kidney dorsal, interspinous pectoralis plane separation of the renal artery; (3) blocking the renal artery, marking the edge of the tumor, the completion of renal tumor resection and wound reconstruction. Perioperative data were compared between the two groups. Results 32 cases of operation were successfully completed. Compared with the traditional transabdominal approach, waist and abdomen combined with three-step method could shorten the operation time (P = 0.014). Perioperative data such as hemorrhage during operation were similar to the traditional methods. Conclusions Laparoscopic partial nephrectomy with improved waist and abdomen combined with three-step method not only retains the advantages of large operating space through abdominal pathways, but also combines the advantages of renal artery separation via the lumbar path, especially when there is variation in the renal arteries Obviously, in-depth clinical comparative studies.