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目的:总结164例后腹腔镜下肾脏切除术的临床经验,初步分析其临床疗效。方法:1998年10月至2006年7月,于后腹腔镜下行肾癌根治术95例和单纯肾脏切除术69例。其中男91例,女73例;年龄2~80岁,平均(49.5±25.7)岁。肾癌患者15例因无痛性全程肉眼血尿就诊,余80例为体检发现。肿瘤大小1.0~8.0 cm,平均(4.3±1.2)cm。术前临床分期:T1N0M040例,T2N0M047例,T3aN0M08例。单纯肾切除患者中肾脏萎缩13例,肾脏积水46例,发育不良3例,肾脏结核7例,均经肾图检查证实患肾无功能。结果:手术时间25~180 min,平均(53.5±27.2)min;出血量20~1 500 ml,平均(150±66)ml;3例中转开放手术。平均住院天数(8.0±4.4)d。随访1~90个月,3例肾癌患者因转移死亡,其余患者均生存。结论:后腹腔镜下肾切除术手术时间短,恢复快,是实用的手术方法。
Objective: To summarize the clinical experience of 164 cases of retroperitoneal laparoscopic nephrectomy and to analyze its clinical efficacy. Methods: From October 1998 to July 2006, 95 patients underwent laparoscopic radical nephrectomy and 69 patients underwent simple nephrectomy. There were 91 males and 73 females, ranging in age from 2 to 80 years (average 49.5 ± 25.7 years). 15 patients with renal cell carcinoma due to painless gross hematuria treatment, more than 80 cases were detected. Tumor size 1.0 ~ 8.0 cm, mean (4.3 ± 1.2) cm. Preoperative clinical stage: T1N0M040 cases, T2N0M047 cases, T3aN0M08 cases. Nephrectomy in 13 patients with renal atrophy, hydronephrosis in 46 cases, 3 cases of dysplasia, 7 cases of renal tuberculosis, renal failure were confirmed by renal examination showed no function. Results: The operation time ranged from 25 to 180 minutes (mean, 53.5 ± 27.2) min. The bleeding volume was from 20 to 1 500 ml (average, 150 ± 66) ml. Three patients underwent open surgery. The average hospital stay (8.0 ± 4.4) d. All cases were followed up for 1 to 90 months. Three patients with renal cell carcinoma died of metastasis, and the remaining patients survived. Conclusions: Retroperitoneal laparoscopic nephrectomy has a short operative time and quick recovery. It is a practical surgical method.